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Safety 

Issues 

in 

Medical 

Museums 



Digitized by the Internet Archive 

in 2011 with funding from 

CARL!: Consortium of Academic and Research Libraries in Illinois 



http://www.archive.org/details/caduceusmuse721991unse 



D U 



Safety 

Issues 

in 

Medical 

Museums 



CADUCEUS 

a museum journal for the health sciences 

Volume VII ■ Number 2 ■ Autumn 1991 
Published by The Pearson Museum 
Department of Medical Humanities 

Board of Editors 

Glen W. Davidson, Editor 

Mary Ellen McElligOtt, Editorial Assistant 

staff 

Barbara Mason, Curator, The Pearson Museum 
M. Lynne Cleverdon, Bnsiyiess Manager 
Carol Faingold, Subscriptions Manager 

Caduceus is published three times a year by The 
Pearson Museum, the Department of Medical 
Humanities, Southern Illinois University School of 
Medicine. Caduceus is cited in Index Medians and in 
Medline, the principal online bibliographic citation base 
of the National Library of Medicine. (Printed on 
acid-free paper, effective with Volume V, No. 1.) 

Subscription Rates 

The subscription rates per year for Caduceus are as 
follows; $34.00 for one year individual (3 issues) and 
$61.50 for two years C6 issues): International subscribers 
should add $2.50 to regular subscription prices to cover 
postage and handling. A single copy of Caduceus is 
S20.00.. 

All subscriphon communications should be 

addressed to' 

Department of Medical Humanities 

Southern Illinois University 

School of Medicine 

P.O. Box 19230 

Springfield, Illinois 62794-9230 

Phone (217)782-4261 



Board of Advisors 

James Connor 

Medical Museum 

University ol" Western Ontario 

London. Ontario NGA ^A5 

M. Patricia Donahue * 

College of Nursing 
University of Iowa 
Iowa City, lA 52242 

James Edmonson 

Howard Dittrick Museum of Historical Medicine 
Cleveland Health Sciences Library 
Cleveland, OH 44106 

Michael Harris 

National Museum of American History 
14th Street & Constitution Ave., N.W. 
Washington, DC 20560 

Christopher Hoolihan 

Edward G. Miner Librar> 
University of Rochester 
Rochester, NY 14642 

Joel Howell 

Department of Internal Medicine 
University of Michigan 
Ann Arbor, "MI 48109 

Adrianne Noe 

National Museum ot" Health and Medicine 

Washington, D.C 20306 

Gretchen Worden 

Mutter Museum 

College of Physicians of Philadelphia 

Philadelphia, PA 19103 



Caduceus is produced for the Department of Medical 
Humanities by the Division of Biomedical 
Communications, Illustration. 
Don Biggerstaff, Director of Biomedical Communications 

Debra Vaninger. Designer 



Copyright 1991 The Board of Trustees 
Southern Illinois University 
ISSN No. 0882-7447 



Contents 



FEA1URE 



FOCUS 



32 



39 



47 



55 



Intolerable, Excruciating, and Troublesome: 
Military Ambulance Technology, 1793-1880 
John S. Haller, Jr. 



Sterilizing Surgical Instruments: 
A Curator's Historical Perspective 
James M. Edmonson 

Decontamination and Sterilization of Medical 
Instmments in Museums 
Eleanor Reilly 

Radioactive and Radium Sources 
in Medical Museums 
Paul W. Frame 

The Preservation and Disposition of Hazardous 
Substances and Controlled Drugs in 
Museum Collections 
Ramunas Kondratas 




■ INSIGHT 

D3 Arsenic, Old Lace, and Stuffed Owls May be 

Dangerous to Your Health: Environmental 
Concerns for Museum Personnel 
Patricia L. IMIIIer 



Cover Illustration: These 
artifacts are from ttie collec- 
tion of the National Museum 
of American History of the 
Smithsonian Institution. On 
the left is a frothing reagent 
bottle in need of immediate 
conservation; the bottle on 
the right is in pristine and 
stable condition. 



Intolerable, Excruciating, and Troublesome: 
Military Ambulance Technology, 1793-1880 





by John S. Haller, Jr. 

Throughout history, armies have 
employed horses, mules, oxen, cam- 
els, llamas, elephants, and human bear- 
ers to transport their wounded in 
battle. Terrain and technology have 
determined the mode of conveyance, 
as have the availability of animals or 
manpower, the seriousness of 
wounds, the ferocity of battle, and the 
availability of civilian transport. Sol- 
diers, stretcher-bearers, and ambu- 
lance attendants have found themselves 
continually challenged to assist the 
non-ambulatory soldier with a combi- 
nation of regular and extemporaneous 
methods. 

Introduction 

The word ambulance was coined 
by the French. It comes from the Latin 
word amhiilare, meaning to walk or 
move. The term was applied to the 
bopital ambulanthy surgeon Domi- 
nique-Jean Larrey during the Napole- 
onic wars. In its original use it applied 
to "temporary hospital establishments, 
organized near the divisions of an 
army, to follow their movements and 



"Battle Scene of the Re- 
serves, " a Thomas Nast draw- 
ing from Harper's Weekly, 
December 27, 1862 

(Courtesy of the Illinois State 
Historical Library) 



CADUCEUS 



to assure early succor to the wounded." 
Larrey and other Europeans used the 
term to include wagons, drivers, sur- 
geons, supplies, and all material 
support. 

Essentially, ambulances were in- 
tended to provide temporary assistance 
to the wounded, thus distinguishing 
them from stationary or fixed hospitals 
where the sick and wounded received 
care and treatment "of a more perma- 
nent character." Nevertheless, accord- 
ing to British Surgeon General Thomas 
Longmore, the term ambulance in En- 
glish and American usage was fre- 
quently misapplied to the two- or 
four-wheeled "ambulance wagon" or 
wheeled transport conveyance that car- 
ried wounded from the battlefield to 
temporary and fixed hospitals. Thus, 
while the term "six ambulances" typi- 
cally referred to six field hospitals at- 
tached to the army and moving with it, 
in England and America it also meant 
"six wagons."" The English and Ameri- 
can corruption of the word, growing 
out of the experiences and language 
of the Crimean War and the American 
Civil War, confused usage to the ex- 
tent that both meanings have prevailed 
into the present day. 

The French Ambulance 

Larrey was appointed medical chief 
of a division of the army on the Rliine 
in 1792, just thirteen months prior to 
the Reign of Terror. He observed that 
the sick and wounded customarily 
walked or were carried to the baggage 
train in the rear of the battle zone; 
there they were attended by surgeons, 



supported by cumhersome fotirgons 
drawn by forty or more horses. Be- 
cause of their size and the confusion 
of battle, few of the /oz</-go«5 reached 
the actual scene of battle until twenty- 
four or thirty-six hours after the en- 
gagement. All too often, soldiers 
unable to leave the firing line because 
of their wounds died of shock or loss 
of blood before medical support 
arrived. 

Larrey did not invent ambulant hos- 
pitals (Isabella of Spain introduced 
them as early as 1487). Rather, he pro- 
vided the existing hospitals with effec- 
tive light transportation in the form of 
two- and four-wheeled vehicles. His 
idea was to follow the advanced guard 
in much the same manner as did the 
"flying artillery" (artillerie volant), thus 
assuring emergency primary surgical 
care as well as removal of the 
wounded from the field. His ambulant 
technique became possible with the 
newer artillery strategies developed 
under Napoleon, including unfettered 
cavalry for greater reconnaissance and 
maneuvering and open-formation 
skirmishes spread over an extended 
front. 

With the consent of General Cust- 
ine, Larrey procured several two- and 
four-wheeled light wagons, organizing 
them into the "flying ambulance" (am- 
bulance volante) that he directed to 
move across the battlefield. Ambu- 
lance volante carried medical officers 
and their assistants right into the front 
line, maintaining contact with troops 
during the engagement. The 
wounded either waited for the ambu- 
lance wagon to arrive or were brought 



AUTUMN 1991 




directly to the surgeons by comrades. 
Once there, the wounded received im- 
mediate medical attention with the sur- 
geons performing amputations and 
extracting bullets. After their wounds 
were dressed, the injured were placed 
in the ambulance wagon and carried 
quickly to a field hospital (chinirgicie 
de bataille): Larrey did not fully per- 
fect his ambulance units until the Ital- 
ian campaign of 1796, when he 
organized his ambulance volante sys- 
tem, with one unit for every ten thou- 
sand men. In total, each ambulance 
unit consisted of 340 men constituted 
into three divisions under the direction 
of a Chief Surgeon. To support a divi- 
sion, Larrey provided two grades of ve- 
hicles: eight two-wheeled, two-horse 
wagons for use in flat country, and 
four four-wheeled, four-horse wagons 
for more hilly terrain. Larrey 's special 
wagon, distinct from the usual supply 
wagon, consisted of an oblong box 



suspended from springs, with doors at 
the front and rear, sliding shutters on 
the sides, and two padded litters on 
castors. The two-wheeled wagon car- 
ried two patients lying full length 
while the four-wheeled wagon accom- 
modated four wounded, providing 
they could lie with their legs bent. 
Larrey supported h's special wagons 
with four storage wagons and one hun- 
dred support personnel, of whom four- 
teen were surgeons. After receiving 
official recognition for his successes, 
Larrey organized ambulance support 
for the Imperial Guard, including fly- 
ing ambulances for Napoleon's Egyp- 
tian campaign of 1799- 

Another French surgeon, Pierre 
Francrois Percy, serving under General 
Jean Victor Moreau, also endeavored 
to improve medical support for the 
wounded on the battlefield. Dis- 
tressed by unnecessary deaths due to 
undisciplined hospital attendants and 



Larrey's two-wheeled 
ambulance 



(Courtesy of California State 
University, Long Beach) 



CADUCEUS 



unorganized transport, Percy organ- 
ized a corps of surgeons for each divi- 
sion and designed a mobile hospital 
called a Wurtz, named for the Austrian 
wagon works (but known popularly as 
"Percy's Wurst" because of its resem- 
blance to a sausage), modeled on light 
artillery wagons, that could move 
close to the battle and provide initial 
surgical support. Each wagon, drawn 
by six horses, carried hand-stretchers, 
instruments, emergency supplies for 
twelve hundred wounded, eight sur- 
geons, and a complement of 120 order- 
lies. Because the surgical wagon was 
too heavy and cumbersome for the bat- 
tlefield, it remained in a safe area near 
the line where it provided aid to those 
able to walk or who were carried by 
stretcher. The Percy surgical wagon 
became an initial hospital station for 
those unable to reach the larger hospi- 
tal train several miles behind the line. 
The wagon demonstrated the value of 
medical assistance for soldiers who 
might otherwise have died from expo- 
sure or from their wounds, providing 
essential support until other arrange- 
ments could be made. Nevertheless, 
Percy's approach left those immobi- 
lized by their wounds on the field 
rather than removing them to safer 
ground. 

During Moreau's campaign in Spain 
in 1808, Percy resolved the problem 
by organizing a trained ambulance 
stretcher-bearer corps (brancardiers) 
to gather wounded during a battle and 
carry them to a surgical support sta- 
tion. Each bearer's lance became a lit- 
ter pole, and two bearers' sashes could 
be laced lengthwise into a litter. Thus, 







any two brancardiers could combine 
their equipment to create a brancard 
or litter. The army assigned thirty-two 
litter-bearers to each company of hos- 
pital attendants; their responsibility 
was to carry wounded to organized 
dressing stations just behind the front 
lines. In a decree of 1813, the French 
Army formally recognized the 
brancardiersyslem, which became 
the embryo of the later regimental 
bearer company. Anticipating the Ge- 
neva Convention of 1864, Percy also 
urged the neutralization of medical 
personnel and stores, including ambu- 
lances and hospitals. 

According to historian Venant A. L. 
Legouest in his Traite de chinirgie 
d'armee, the ideas of both Larrey and 
Percy, which were endorsed by Napo- 
leon, laid the groundwork for the sub- 
sequent ambulance support systems 
adopted by most European armies. 
Notwithstanding Legouest's remarks, 
however, the endorsement by 



Percy's ambulance 

(Courtesy of California State 
University, Long Beach) 



AUTUMN 1991 



Napoleon extended only to Larrey and 
Percy and not to their plans for a per- 
manent surgical corps for the entire 
French Army. The Emperor's distaist 
of doctors, combined with his belief 
that medical officers should not be an 
integral part of the army, prevented 
the full establishment of flying hospital 
attachments. Moreover, other nations 
seemed not to notice or respond to 
Larrey's ideas except perhaps in the- 
ory. Change came slowly as the Brit- 
ish and Russians could attest in the 
Crimea some fifty years later. 

By mid-century, however, almost 
every European army employed some 
combination of .stretcher-bearers and 
ambulance wagons. The Prussian 
Army, for example, attached "bearer 
companies" to the flying detachments 
of the light hospitals of army corps. 
Each bearer company consisted of 202 
noncommissioned officers and men, 
with forty-five hand-litters and twelve 
pairs of caitches. Wounded on the 
field of battle were provided with first 
aid — bandages, tourniquets, and other 
operations essential to preserve life. 
The flying detachment prevented sol- 
diers from leaving ranks to carry their 
wounded comrades to safer positions 
in the rear, a situation that all too fre- 
quently had become an excuse to 
avoid battle. The detachment also pro- 
tected the wounded from thieves and 
marauders. 

A second line of support was pro- 
vided in a sheltered position near the 
engagement, where five medical offi- 
cers, an apothecary, and ten atten- 
dants received the wounded. Fotir 
ambulance wagons, as well as a medi- 



cine and bandage wagon and a re- 
serve wagon, supported the section. 
Finally, a third support group — usually 
a village or farm — supplied medical at- 
tention further in the rear of the battle 
zone. From that station, the wounded 
were transported to fixed hospitals. 
This organizational scheme, originat- 
ing out of the experiences of the 
French Army, endured with minor 
changes into the First Worid War.^" 



Below are Baron Percy's 
stretcher-bearers in march- 
ing order 

(Courtesy of National Library 
of Medicine) 




CADUCEUS 



Dandies and Camel Litters 

In the corps of the Punjab Frontier 
Force in India in the early nineteenth 
century, the common (or duree) 
dandy served the bearer needs of the 
army. Comprised of a hammock slung 
over two poles of thick bamboo, six- 
teen feet in length, the dandy earned a 
reputation for transporting wounded 
on hilly terrain and for providing com- 
fort to the patient over long marches. 
For the severely wounded, however, 
the choice was the stronger bareilly 
dandy, whose hammock could fold 
into a sitting or upright position, which 
provided more comfort for fracture 
cases and wounds of the chest and 
upper extremities; four bearers were 
needed for the bareilly dandy. 

Litters provided transport in the 
1830s and 1840s in British India and 
during the Afghan campaigns. The 
term "litter" derived from the Latin 
lectus, meaning a couch or bed. Ser- 
vants who carried the bed were called 
lecticarii, or litter-bearers. Indian na- 
tives named it Kujjawa because of its 
resemblance to a hamper used in Af- 
ghanistan to transport fruit over long 
distances. The dhoolie, which became 
the staple transport for the sick and 
wounded in England's eastern wars, 
was a closed-in litter carried by two or 
four bearers with two others in atten- 
dance. During campaigns in India, six 
hundred dhoolie-bearers served a 
fighting battalion of one thousand. Al- 
though some advocates recommended 
the dhoolie for all European conflicts, 
the military approved its use only in 
areas of large populations, as in the at- 



tack upon Canton in 1857 and in the 
Indian Mutiny of 1859." 

In contrast to the dhoolies, camel lit- 
ters could bear greater weight over 
longer distances. Four men could 
travel upright, or two horizontally, and 
the frame included an awning and cur- 
tains that shielded patients from the 
sun. On the battlefield, the British 
Army preferred camel litters to bearers, 
who were apt to flee. Convoys of 
camel litters were used for transpor- 
tation of wounded to distant towns or 
villages for recuperation. The British 
considered the camel kujjawa more 
cost effective than the dhoolie for con- 
valescents, but because of the peculiar 
swaying motion of the camel the 
dhoolie was preferable for the seri- 
ously sick and wounded. 

Cacolets and IVIule Litters 

After the medical evacuation prob- 
lems encountered in the Siege of 
Sebastopol in the Crimea, the English, 
French, and Sardinian armies em- 
ployed pack mules for litters and 
cacolets. United States Major Richard 
Delafield, who was sent as an ob- 
server of the Crimean War in order to 
observe "ambulances and other means 
for transporting the sick and 
wounded," endorsed chairs and litters 
for the American Army. Delafield theo- 
rized that mule litters would be an ad- 
vantage in the congestion that often 
prevented the passage of ambulance 
wagons — first preference being given 
to artillery, ammunition wagons, rein- 
forcements, and food. " Accordingly, 
in May, 1861, the Quartermaster's 





Top, common dandy 

Bottom, bareilly dandy 

(Courtesy of California State 
University, Long Beacti ) 



AUTUMN 1991 



Department purchased for the Union 
Army mule litters and cacolets 
patterned after those used by the 
French Army in Algeria and in the Cri- 
mean War. Tiffany and Co. of New 
York and G. Kohler built the convey- 
ances and sold them with animals spe- 
cially trained for the purpose. By July, 
1862, the Union Army was provisioned 
with three hundred mule litters and 
cacolets. 

Despite those purchases and 
Delafield's good intentions, the army 
in the field objected to experimenting 
with the conveyances. Efforts to intro- 
duce mule litters and cacolets at the 
Battle of Fair Oaks (May 31 through 
June 1, 1862), in the Shenandoah Val- 
ley campaign under General Nathaniel 
P. Parks, and at the Battle of Antietam 
were futile. Under battle conditions, 
armies used available horses and 
mules for other services, particularly to 
carry munitions. Further, many sol- 
diers regarded the litters as unneces- 
sary baggage, a burden to transport, 
and obviously inconvenient during bat- 
tle. Both medical men and soldiers 
preferred improvised wheeled ambu- 
lances and hand litters. As Surgeon 
George Suckley, Medical Director of 
the Eleventh Corps of the Army of the 
Potomac, bluntly stated in a letter of 
March 20, 1863, to SurgeonJ. H. 
Brinton: 

There are no cacolets in this 
corps, and I want none. Three 
hundred and fifty pounds 
weight [with patient] is too 
much for a mule's back over 
rough ground, encumbered 



by bushes, stones, logs and 
ditches. Among trees, 
cacolets will not answer at all; 
although used in European 
services and in Algeria, they 
have there been employed 
under some favorable circum- 
stances, either on plains or on 
open rolling country. Here 
they would prove, I sincerely 
believe, only a troublesome 
and barbarous encumbrance, 
cruel alike to the wounded 
and the pack-animals. 




The effort to introduce cacolets 
proved to be an expensive waste of 
time. At a cost of $21,000 (not count- 
ing the purchase and training of 
mulesX the cacolet experiment ended 
in failure; the Quartermaster General 
could not demonstrate that even one 
wounded man was carried or even 
that officers in the field showed a will- 
ingness to test the equipment. Mules 



British Crimean mule litter 

(Courtesy of California State 
University, Long Beach) 



CADUCEUS 



originally purchased with the cacolets 
were eventually transferred to ambu- 
lances and general purpose wagons. 
Cacolets and mule litters were also 
unsuccessful in India during the Sepoy 
rebellion and in New Zealand during 
the Maori War of I860. They were 
marginally useful in the Italian War of 
1859, the Franco-Austrian invasion of 
Mexico in 1864-1865, and the French 
expedition into Algeria in 1865. In the 
latter campaign, the French organized 
an actual mule ambulance system. For 
every thousand soldiers, the army pro- 
vided a field hospital and eighteen 
mules with cacolets. In the Mexican 
campaign, officers and men com- 
plained that the cacolets were unser- 
viceable on narrow mountain passes, 
and horses and mules were unable to 
bear the weight of the wounded. The 
varying gaits of the animals intensified 
the discomfort of the injured, and the 
high center of gravity not infrequently 
caused the loss of both animal and sol- 
dier down a deep ravine. 

Stretchers 

Only the stretcher, with human 
bearers, could provide the total flexibil- 
ity called for by Delafield in I860: 
"The requisites for an ambulance 
should be such as to adapt to the bat- 
tlefield, among the dead, wounded, 
and dying, — in ploughed fields, on hill- 
tops, mountain slopes, in siege batter- 
ies and trenches, and a variety of 
places inaccessible to wheel-carriages, 
of which woods, thick brush, and 
rocky ground are frequently the locali- 
ties most obstinately defended. " 



While armies criticized mule litters 
and cacolets, they almost unanimously 
supported the stretcher as the best con- 
veyance for the sick and wounded. 
During the American Civil War, the 
Union Army issued 52,489 stretchers to 
its troops, or approximately twenty- 
five per thousand men. By nineteenth- 
century standards, that liberal 
allocation, together with a supply of 
ambulance wagons, represented a 
magnitude "as had never been wit- 
nessed in any previous war." The 
stretchers were of different designs, be- 
ginning with the bulky and non-fold- 
ing Satterlee ( named after Surgeon R. 
S. Satterlee), which was also known as 
the U.S. Regulation Army Litter. Next 
was the Halstead folding stretcher, 
which, with minor modifications, con- 
tinued in use through the 1880s." 

The Satterlee weighed nearly 
twenty-five pounds and was twenty- 
seven inches wide; its poles, made of 
red ash and passing through a canvas 
bed, connected at either end to 
wrought-iron bands that served as 
legs. The Schell stretcher, designed by 
Assistant Surgeon Henry S. Schell in 
1862, was utilized as a bed in hospital 
tents. The eight-foot Halstead 
stretcher, issued by the Medical 
Purveyor's Department, connected to 
folding wooden legs fourteen and a 
half inches long. Although slightly less 
heavy than the Satterlee, its weight de- 
tracted from its usefulness; moreover, 
the legs loosened over time and its 
awkward staicture inhibited use in am- 
bulance conveyances, forcing bearers 
to remove the wounded soldier from 
the stretcher before placing him in the 




Mule cacolets or chairs 

(Courtesy of National Library 
of Medicine) 



10 



ambulance. Nearly thirteen thousand 
Halsteads were furnished to Union 
troops during the Civil War. (It was 
not replaced until 1895, when a new 
model, nine pounds lighter, was intro- 
duced. The new stretcher folded com- 
pactly for easy carrying and featured 
fixed wrought-iron stirrup-shaped legs 
that raised it four inches for transport 
in a regulation ambulance.)" 

At the Paris Exposition of 1867, 
Gauvin, a medicin-majorm the 
French Army, introduced a spring 
stretcher intended for use in railroad 
cars. One year later, however, the 
Prussian government ordered railroads 
to utilize the ordinary field stretcher in 
transport, a decision based in large 
measure on the experiences of the 
Union Army. The only change intro- 
duced by the Prussian government 
was a folding backrest with different 
angles of elevation and two padded 
side pieces to prevent the recumbent 
patient from rolling off."" 

The British employed a stretcher 
known as the Mark I and later patterns 
devised by Surgeon-Major Paris 
known as Mark IV and Mark V. The 
Mark IV and V offered the advantage 
of wooden rollers, which facilitated 
their use in ambulances or other trans- 
port vehicles. Hammocks were fa- 
vored during shipboard transportation 
and during the Ashanti War of 1874. 
In emergency situations, stretchers 
could also be constructed of such avail- 
able materials as hay, straw rope, infan- 
try straps, belts, or a combination of 
rifles and coats. Even telegraph wires 
were, used as makeshift stretcher 
webbing. 



Wheelbarrows and Wheeled Litters 

A thoroughly vernacular form of am- 
bulance transport used almost exclu- 
sively by Europeans was the 
wheelbarrow or hand-wheel litter, de- 
signed with a single wheel and 
mounted with two support legs to pro- 
vide stability. The wheelbarrow prom- 
ised rapid removal of wounded from 
battle while reducing the number of 
animals needed for transport service; it 
also lessened bearer fatigue. Instead 
of the two liearers required to carry a 
stretcher, a single attendant pushed a 
hand-wheel litter. Although not rec- 
ommended for long hauls, armies pre- 
ferred the wheelbarrow for the short 
distance between where the soldier 
fell and the nearest surgical 
assistance." 

Larrey noted in his Memoires de 
chinirgie militaire. et c a mpag lies ihal 
he borrowed wheelbarrows from Sax- 
ony villagers extensively in the sum- 
mer of 1813 during the Russian 
campaign after the battle of Bautzen. 
When filled with a mattress, straw, 
small branches, or a sack, the carts 
adapted easily as ambulance transport. 
Upon Larrey's recommendation, bear- 
ers utilized that conveyance to trans- 
port the wounded to Dresden."' 

The earliest design of wheelbar- 
rows specifically intended for military 
ambulance use followed the recom- 
mendation of Surgeon George Evans 
of London after the Crimean War. His 
open hand-wheel litter carried one sit- 
ting soldier and another soldier in a re- 
cumbent position. As an advantage, 
according to Evans, the litter also 



CAOUCEUS 





converted to an operating table in the 
field. Despite its versatility, a board of 
army medical officers in 1855 found it 
unacceptable. In I860, England dis- 
patched a number of two-wheel ambu- 
lance barrows, litters, and cacolets to 
assist its forces in China. The so-called 
"China ambulance" served as a cart to 
carry provisions from the rear to the 
front and, by rearranging the rear 
board and sides, transformed from cart 
to ambulance. Given the ease of river 
transportation during the China cam- 
paign, however, advocates of the bar- 
row never fully tested its utility." 

In 1864, before the war with Den- 
mark, Ignaz Josef Neudorfer, an Aus- 
trian military surgeon and professor of 
surgery at the University of Prague, de- 
signed a two-wheel litter inspired by 
his experiences at a field hospital dur- 
ing the Italian campaign in 1859- His 
conveyance, which he claimed could 
move easily over fields and rough ter- 
rain, was strong, light, inexpensive. 



and portable. The more successful 
Neus Two-Wheeled Litter, designed by 
government carriage builders in Berlin 
and constructed on principles similar 
to those of Neudorfer, saw extensive 
use in the Austro-Prussian War against 
Denmark in 1864. In fact, during the 
war, a number of hand-wheel car- 
riages were specially constructed and 
tested. The favorable experience 
gained, particularly after the assault on 
the forts of Duppel, resulted in the de- 
velopment of many new wheeled con- 
veyances intended to be powered by 
man. Proponents claimed that hand- 
wheel litters ensured more rapid re- 
moval of the wounded than by 
ordinary stretchers; that they lessened 
the fatigue of bearers; that they 
avoided the necessity of using animals 
in bearing cacolets and mule litters; 
and that they were the preferred con- 
veyance between the battleline and 
the first and second lines of surgical as- 
sistance. Nevertheless, British Deputy- 



At left is Neudorfer's two- 
wheeled litter for the trans- 
port of one or two wounded 
soldiers; at right is the litter 
folded up and packed for 
carriage. 

(Courtesy of California State 
University, Long Beach) 



12 



AUTUMN 1991 



Inspector General Thomas Longmore 
concluded that although wheeled bar- 
rows might be appropriate for war the- 
aters with clear and level ground, the 
British Army would continue to rely 
on stretcher-bearers and mules. 

United States Ambulance Wagons 

Ambulance wagons designed specif- 
ically to support the sick and wounded 
did not exist in the United States until 
1859. The army had attached no 
ambulance transport to its forces in the 
Florida War of 1838, the War with Mex- 
ico, or the expeditions into Indian terri- 
tories prior to the Civil War. What 
transport did exist consisted of impro- 
vised army wagons, impressed civilian 
vehicles, ox carts, and just about any- 
thing else available. 

In 1858, a Medical Board consisting 
of Surgeons R. S. Satterlee and C. H. 
Lamb and Assistant Surgeon C. H. 
Crane recommended a four-wheeled 
ambulance wagon named the Moses 
(for Army Assistant Surgeon Israel 
Moses) for service in the West. Resem- 
bling a cross between an omnibus and 
an ice cart, the Moses was drawn by 
six horses or mules. It was open, with 
an entrance from the rear. It provided 
seating capacity for nineteen, includ- 
ing the driver — fourteen injured sol- 
diers could be accommodated in two 
benches running lengthwise, with an 
additional four on the front seat with 
the driver. At night, with the exten- 
sion of a canvas shelter, the Moses 
could sleep thirty under its tent-like ar- 
rangement. The board thought highly 
of the Moses design, considering it 



well suited for field and frontier ser- 
vice and for comfortable transport of 
the sick and wounded on long 
marches. No action followed the 
board's recommendation, however, 
and apparently no vehicles were built. 

Developed soon after and ap- 
proved by the Medical Board were the 
two-wheeled Finley (named for Sur- 
geon Clement A. Finley) and the two- 
wheeled Coolidge (for Assistant 
Surgeon Richard H. Coolidge), both of 
which had springs and mattresses on 
the wagon floor. The army attempted 
to test the wagons in the military de- 
partments of Texas, New Mexico, 
Utah, California, and Oregon. Yet, ac- 
cording to an observer in the North 
American Review, "No man who has 
once ridden in the two-wheeled ambu- 
lance would willingly get into one 
again, even if he were well." Soldiers 
referred to the two-wheeler as the 
"avalanche" because of its jarring ride. 
Even though the two-wheeled ambu- 
lance had advocates among its medical 
staffs, the Union armies abandoned 
most of them by 1863 because, accord- 
ing to Surgeon-General Joseph K. 
Barnes, "their motion was intolerable 
and excruciating [and] wounded men 
begged to be taken out."" 

More acceptable was the four- 
wheeled Tripler (named for Surgeon 
Charles S. Tripler), also recommended 
in 1859, which carried four litters in 
two tiers and was drawn by four 
horses. The Tripler was produced by 
the hundreds and used throughout the 
Civil War. Ten feet long and four feet 
wide, the Tripler offered a remarkable 
range of seating: four spring mattresses 



CADUCEUS 




The "Moses" ambulance 
wagon and tent 




The "Finley" two-wheeled 
ambulance wagon 




The "Coolidge" ambulance 
wagon 



AUTUMN 1991 




The "Tripler" ambulance 
wagon 




The "Wheeling" or "Rose- 
crans" ambulance wagon 




The "Rucker" ambulance 
wagon 

(All photos on these pages 
are courtesy of California 
State University, Long Beach) 



15 



CADUCEUS 



( rw'O lying on iron rails on the wagon 
bed and two hanging from the sides 
twenty-two inches above the floor), a 
front seat for three persons, and tail 
seating that held an additional three 
persons. Also built in was a medicine 
chest. The entire carriage hung on 
platform springs to reduce jolting." 

The ambulance wagon most exten- 
sively used during the Civil War was 
the Wheeling or Rosecrans (named for 
General William S. Rosecrans), which 
weighed approximately 750 pounds 
and could accommodate eleven or 
twelve seated passengers or two in a 
recumbent position and two or three 
sitting. Lighter than the Tripler and 
drawn by two horses, the four- 
wheeled Wheeling had ample room 
for patients, water tank, extra litters, 
and medical supplies. Although the 
body of the wagon rested on four ellip- 
tical springs, the ride was tortuous. A 
soldier lying full length on the seat or 
bed "had to hold on with both hands 
to keep from falling to the floor" even 
on the reasonably smooth roads of 
Maryland. Lightweight, simple in con- 
struction, and easily repaired, the 
Wheeling not only survived the Civil 
War after participating in nearly every 
campaign but also accompanied 
troops throughout the 1870s in the dif- 
ficult terrain of the western service. 
Known affectionately as the "old yel- 
low ambulance," the Wheeling elicited 
the support of faithful stalwarts. 
Around its history, a host of stories — 
even folklore — developed. As a result, 
replacements for the Wheeling met 
with considerable skepticism. 



The four-wheeled Rucker (based on 
the design of Brigadier General Daniel 
H. Rucker) was built toward the end of 
the Civil War by the government repair 
shops in Washington; it featured 
ample floor space, cushioned leather 
seats and backs, floor springs to sup- 
port litters, and a box under the 
driver's seat for instruments, medicine 
chests, panniers, and other items. The 
Rucker carried two stretchers fitted 
with rollers to facilitate loading and un- 
loading. In addition, the ambulance 
could accommodate two additional 
stretchers suspended from the roof. 
The body of the Rucker rested on plat- 
form springs, and its front wheels were 
small to improve turning radius. Al- 
though the ambulance weighed 1,120 
pounds, exceeding the Wheeling by 
370 pounds, it proved to be quite dura- 
ble compared to European designs. At 
the Paris Exhibition of 1867, the U.S. 
Rucker — as modified by dentist Dr. 
Thomas Evans of Paris to include bet- 
ter ventilation, extra springs, and a rear 
seat — received one of the prizes of- 
fered for the best ambulance. Unlike 
the lighter European designs that were 
capable of cariying only one or two 
wounded, the Rucker had an almost 
"democratic" appearance, able to carry 
four litters and intended for rugged ter- 
rain and long distances." 

The Howard Ambulance, named for 
Assistant Surgeon Benjamin Howard 
and constructed in October, 1864, car- 
ried four recumbent patients and also 
provided rollers for ease of moving. 
Also, the Howard featured a suspen- 
sion arrangement to assist patients with 
fractured limbs. Although promising 



16 



AUTUMN 1991 




An Army wagon fitted up ac- 
cording to Langer's design 
as an ambulance wagon 

(Courtesy of California State 
University, Long Beach) 



in its design, thie Howard was the heav- 
iest of the four-wheeled ambulances at 
1,232 pounds. It had semi-elliptical 
springs and India rubber blocks that 
were intended to ser\'e as shock ab- 
sorbers, and it offered great conve- 
nience for loading and unloading 
patients. Despite these improvements, 
however, it was plagued with chronic 
repair problems. 

In the winter of 1864-1865, the Fifth 
Army Corps Depot Hospital near 
Petersburg introduced into use an am- 
bulance wagon designed by Dr. I. Lan- 
ger that carried either eight sitting 
patients or six sitting and two recum- 
bent ones. Although little more than 
an army wagon refitted as an ambu- 
lance wagon, Langer's model offered 
greater seating capacity, easier loading 
and unloading, and an apparatus for 
suspending two patients with thigh 
fractures. Following a review in April, 
1865, a board consisting of Colonel R. 
O. Abbott and Assistant Surgeons J. J. 



Woodward and William Thomson con- 
cluded that the Langer model was "in- 
geniously complicated" and therefore 
less useful than either the Wheeling or 
Rucker wagons." " 

Union Army recommendations 
called for ambulance transportation to 
support a ratio of forty wounded per 
thousand, and that both two- and four- 
wheeled wagons be available. The 
overall distribution per unit was: one 
two-wheeled ambulance to each com- 
pany, one four-wheeled and five two- 
wheeled wagons to a battalion, and 
two four-wheeled and ten two- 
wheeled wagons to a regiment. 

By contrast, the Confederate Army 
had few ambulances. By 1863, Missis- 
sippi troops could muster only thirty- 
eight wagons, and by 1865 not one 
could be found in the entire brigade in 
the Department of West Virginia and 
East Tennessee. Instead, medical per- 
sonnel improvised as best they could, 



17 



CADUCEUS 



drawing upon army wagons and other 
transport." ' 

Following the war and after exten- 
sive and controversial tests involving a 
number of competing designs (includ- 
ing even an armored ambulance that 
converted into a portable rifle pit in- 
vented by H. N.Jasper), the 1878 
Ambulance Board recommended a 
new vehicle known as the McDermott. 
Not until modified by a revised set of 
specifications approved by Quarter- 
master General M. C. Meigs was the 
ambulance adopted by the Army Medi- 
cal Depamnent in 1881. Known by 
many teamsters as "the mule killer" be- 
cause of its excessive weight — fifteen 
hundred pounds — the McDermott suf- 
fered from not only chronic brake 
problems but also a flawed wheel de- 
sign that affected its ability to manage 
ruts. Nevertheless, it had ample floor 
space, cushioned leather seats and 
backs, lateral floor springs to support 
litters, and sufficient space for storing 
instruments, water, and other essen- 
tials. According to one historian, the 
McDermott "was a synthesis of the 
best features of American and Euro- 
pean contemporary design." The am- 
bulance saw service in the post-Civil 
War army at Bear's Paw Mountain, the 
Powder River, and at camps of instruc- 
tion in the Departments of Missouri, 
Platte, Dakota, and Arizona. It was re- 
placed in 1892.-^"' 

The Railroad as Ambulance 

The earliest European test of rail ca- 
pability for medical evacuation oc- 
curred in the Crimea with the five-mile 



railway from Balaclava to battery posi- 
tions at the front. Although a locomo- 
tive hauled the eight-wagon train over 
the first two miles, the remainder of 
the trip was accomplished by a station- 
ary engine for the steep incline and 
then by horses. Europe's armies also 
used the railroad as ambulance sup- 
port at Chalons in 1857 and during the 
Italian War of 1859 when the Austrian, 
French, and Sardinian armies trans- 
ported wounded on passenger trains 
to hospitals in Milan, Brescia, Pavia, 
and Turin. In all, 89,000 casualties 
moved by rail during that conflict. 
Subsequently, French military surgeon 
Perier converted baggage cars for hos- 
pital transport and Ernst J. Gurlt of Ber- 
lin made a similar proposal for 
carrying wounded in hammocks sus- 
pended by iron hooks from the panels 
of freight cars. Despite those early de- 
signs, armies undertook few improve- 
ments or special arrangements. Most 
wounded were simply laid on straw 
mattresses or directly upon loose straw 
that covered the floors of freight cars. 
The railroad was al.so used for medical 
evacuation in the Schleswig-Holstein 
War of 1864.-"^^ 

During the American Civil War, ar- 
mies and private relief organizations 
tested the full potential of the railroad 
over great distances. Indeed, the war 
has often been called a "railway war," 
with military officers and civilians 
working together to adapt railroads to 
the strategic moves of troops. The rail- 
road brought new mobility to armies, 
enabling commanders to move sol- 
diers, horses, mules, artillery, and bag- 
gage long distances and to deploy 



18 



AUTUMN 1991 




Interior of an improvised hos- 
pital car 

(Courtesy of California State 
University, Long Beach) 



them effectively and quickly against an 
enemy force. The role of trains in 
transporting sick was a matter of some 
controversy, however. Military surgeons 
who feared untimely delays argued that 
severely wounded soldiers (i.e., those 
with wounds of the body cavity, large 
joints, or shot fractures) should be re- 
garded as neutrals and treated as near 
the field of battle as possible. Neverthe- 
less, the pressures for speedy removal 
prevailed as railroad transport promised 
to alleviate the harshness of the front 
lines and also to reduce the number of 
combatants required to attend the sick 
and wounded during critical battle con- 
ditions. Clearly, the wounded who sur- 
vived the trip received better treatment 
at a base hospital away from the chaos 
of battlefield medicine. 



The first occasion for conveying 
sick and wounded occurred in August, 
1861, following the Battle of Wilson's 
Creek in Central Missouri. After falling 
into enemy hands and then being pa- 
roled, Union wounded collected at the 
southwestern terminus of the St. Louis 
Railroad at RoUa, where freight cars 
were requisitioned for transporting the 
wounded approximately 103 miles to 
St. Louis hospitals. Medical officers ex- 
perimented with various extempo- 
raneous methods for carrying the 
seriously wounded in freight cars, in- 
cluding suspending litters from poles 
attached to the floor and roof and 
building wooden bunks filled with 
straw. In most of these cars, workers 
also attempted to improve ventilation 
by sawing out spaces in the walls.' 



.38 



19 



CADUCEUS 



The Union Army drew its ambu- 
lance cars from several different 
sources. It requisitioned the largest 
number from empty supply trains sta- 
tioned at depots close to the war the- 
ater; others it drew from worn-out or 
condemned freight or passenger cars, 
which were altered to carry sick and 
wounded. And when available, the 
military (or U.S. Sanitary Commission) 
built hospital cars from new operating 
stock.^^ 

The Bureau of Construction of Mili- 
tary Railways, the Surgeon General, 
and the U.S. Sanitary Commission 
closely supervised the special rolling 
stock. Assistant Superintendent of Mili- 
tary Railroads J. McCrickett designed 
the hospital cars on the Orange and Al- 
exandria Railroad, which ran between 
the army's encampment near Cul- 
peper, Virginia, and base hospitals at 
Alexandria and Washington. The car, 
forty-five feet in length, transported pa- 
tients in both stretchers and chairs. Mc- 
Crickett arranged the stretchers along 
three tiers of poles, the first tier consist- 
ing of permanent couches with mat- 
tresses, and the second and third tiers 
of field stretchers suspended by metal, 
rubber, or leather straps.^ 

The railroads were an essential part 
of the transport system in Maryland 
and Pennsylvania. More than nine 
thousand sick and wounded moved 
over the Aquia Creek Road following 
the Battle of ChancellorsviUe (May 2- 
4, 1863). In the aftermath of Gettys- 
burg (June 27-July 4, 1863), the army 
transported more than fifteen thou- 
sand from field hospitals to base hospi- 
tals in Baltimore, New York, 



Harrisburg, and Philadelphia. In most 
instances, boxcars from returning sup- 
ply trains were used as the vehicles of 
transport, with stretchers placed on 
floors covered with hay to cushion the 
jarring motion of the train. Each car 
contained a water cooler, tin cups, bed 
pans, and other essentials. The Phila- 
delphia and Reading Railway Com- 
pany fitted freight cars using the same 
stretchers that supported patients in 
the ambulance wagons. Cars con- 
structed on this basis contained fifty- 
one berths, with a seat at each end for 
an attendant."* 

By 1864, three hospital trains, each 
consisting often to twelve cars, con- 
nected the advanced army with base 
hospitals in Louisville. They were fit- 
ted under the supervision of Surgeon 
George E. Cooper, Medical Director of 
the Department of the Cumberland, 
and Surgeon O. O. Herrick of the 
Thirty-fourth Illinois Volunteers. In ad- 
dition to cars fitted for casualties, there 
were several baggage cars, a kitchen 
car, a dispensary car, and accommoda- 
tions for a medical officer. In that man- 
ner, wounded moved the 185 miles 
from Nashville to Louisville. 

Another hospital car, designed by 
physician Elisha Harris and built by 
the U.S. Sanitary Commission, pro- 
vided a gangway through the center of 
each carriage. Quartermaster-General 
Meigs placed all cars at the govern- 
ment depot at Alexandria under 
Harris's disposal. There, in coopera- 
tion with the three railway companies 
owning the line between Washington 
and New York, Harris prepared his 
cars. Using India rubber tugs, he 



AUTUMN 1991 



suspended three tiers of beds, sixteen 
of which swung along each side of the 
hospital car. Those soldiers able to sit 
filled invalid chairs and broad 
couches. " 

Ambulance trains traveled unmo- 
lested. By 1862, Harris hospital cars 
were running regularly between Mari- 
etta, Georgia, and Louisville, Ken- 
tucky. Daily at least one train left the 
vicinity of the field hospitals for the 
175-mile trip to the base hospitals. Its 
yellow flag with green border, three 
red lanterns, and bright scarlet smoke- 
stack were recognized symbols, re- 
spected by the Confederate Army, 
which under orders from General Na- 
than B. Forrest and Colonel John Mor- 
gan, allowed it to proceed while 
armies seized or wrecked other trains. 
Until Sherman's march to the sea, the 
ambulance trains ran regularly from 
the front to base hospitals. 

In 1864, the Union Army estab- 
lished a base depot hospital at the junc- 
tion of the James and Appomattox 
rivers in Virginia. The depot became 
the center for transport to hospital 
steamers and other recuperation cen- 
ters. Most troops transported to the 
depot arrived in boxcars that had origi- 
nally carried supplies to the war the- 
ater. Although designed to 
accommodate nine to ten recumbent 
patients, each car typically carried 
twenty wounded. Lack of hay and 
straw meant that wounded frequently 
had to lie on bedding made of dry 
leaves or evergreen boughs. Eventu- 
ally the army converted a number of 
passenger cars by erecting rows of 
staunchions from which they sus- 



pended litters. The suspension system 
carried certain risks since the jolting 
over poorly laid rails occasionally 
caused litters to break from their con- 
necting rings. 

In the western theatre, a similar sys- 
tem of rail ambulances proved equally 
effective. Although transportation re- 
mained within the jurisdiction of the 
Quartermaster's Department, the Sani- 
taiy Commission continued to urge the 
transfer of the management function to 
the Medical Bureau.'* By the end of 
the war, the North had moved 225,000 
of its sick and wounded by rail from 
the war theatre to general hospitals in 
the rear. 

The Confederate Army provided no 
regular system of ambulance trains, re- 
lying instead upon extemporaneous 
passenger cars, freight cars, and open 
boxcars. Dr. Samuel Preston Moore, 
Surgeon General of the Confederate 
Army, recalled in 1875 that such vehi- 
cles "were used to transport our 
wounded from the field to the hospi- 
tals. The cars were bedded with straw 
or leaves, whichever was most conve- 
nient. The method was found to be 
objectionable on account of the bed- 
ding becoming foul and unpleasant 
and was discontinued and blankets 
were placed on the floor when they 
could be procured." Lacking mbber 
rings to suspend litters in the manner 
devised by Elisha Harris, the Confeder- 
ates substituted ropes.'* 

Perhaps the most important ambu- 
lance innovation of the Civil 'War was 
the use of the same stretcher for three 
processes: removal of the wounded 
from the field of battle, transport on 



CADUCEUS 



the railroad or steamer, and support 
upon arrival at the base hospital. For 
that and other innovations, military sur- 
geon Friedrich von Esmarch, professor 
at Kiel, remarked that the Union Army 
and "the world-renowned Sanitary 
Commission" had accomplished "the 
transport of wounded on railways so 
perfectly as to leave little to be desired, 
[and] might well serve as an example 
to European States in future wars."** 
The railroad was later used in the 
Austro-Prussian-Italian conflict of 
1866, the Franco-Prussian War of 1870- 
1871, and the Servian-Bulgarian War 
of 1885-1886. During the Franco-Pms- 
sian War, Germany moved its 
wounded to the nearest railhead for 
immediate transport to hospitals situ- 
ated near the frontier, thus eliminating 
the need for field hospitals. Prior to 
World War I, Britain used railways in 
the Zulu War of 1879, the Boer Rebel- 
lion of 1881, the Egyptian campaigns 
of 1884 and 1885, Rhodesia in 1896, 
and the Sudan in 1898. The railroad 
also played an increasingly important 
role in the Turco-Greek War of 1897, 
the Boer War of 1899-1902, the Russo- 
Japanese War of 1904, and the Balkan 
War of 1912-1913. 



Native American Travoises and Western 
Litters 

The origin of the travois — a crude 
conveyance of animal hide ribbing 
connected to two poles — is obscure. 
As early as Pontiac's War in 1763, colo- 
nists adopted the basic Native convey- 
ance to transport their wounded. 
Within decades, Lewis and Clark and 
medical officers on many frontier posts 
had copied the technique. 

Army medical officers made fre- 
quent use of the travois and its imita- 
tions. Pack animals pulled hastily 
contrived hammocks or pallets or even 
sacks of hay, straw, leaves, or grass. 
During the Seminole War of 1835- 
1836, for example. Surgeon Richard S. 
Satterlee improvised two-horse litters 
made from blankets and hides of cattle. 
During the same campaign. Captain 
H. L. Thistle of the Louisiana Volun- 
teers designed a single-horse litter. 
Years later, during the war with Mexico 
and the 1852 expedition against the 
Apache, the army employed a 



Dakota Indian Travois 

(Courtesy of California State 
University, Long Beach) 




22 



AUTUMN 1991 



two-horse litter not unlike that de- 
scribed by Randolph B. Marcy in his 
Prairie Traveler, a Handbook for Over- 
land Expeditions i\859). The double- 
mule litter remained a popular form of 
transport for the sick and wounded 
during the western campaigns of the 
1870s. The poles connected to a net- 
work of ribbing over which a soldier 
spread a buffalo robe, blankets, and 
pillows. That ribbing often came from 
the skins of dead horses or ponies. 
The cavalry relied upon mule litters in 
mountainous terrain and in other off- 
road engagements. 

The Greenleaf, Cleary, Girard and 
McDougill travoises were used by the 
army in transporting sick and wounded 
when wheeled vehicles proved imprac- 
tical. The McDougill travois, invented 
by Captain Thomas M. McDougill, was 
a horizontal litter consisting of two 
poles eighteen feet in length that sup- 
ported a canvas bed strengthened by 
metal rods. The Greenleaf travois, de- 
signed by Deputy Surgeon General 
Charles R. Greenleaf, packed in a bun- 
dle nine feet long and one foot in di- 
ameter for portability. " The horse 
litter proposed by Assistant Surgeon 
Peter A. J. Cleary originated from his 
experiences and observations at Fort 
Sill in the Indian Territory in 1875."' 

Concern for the transport of the sick 
and wounded led the Military Board of 
1859 to recommend that the two-horse 
litter be issued to frontier posts. The 
army continued to rely upon the two- 
horse litter as late as 1873, with impro- 
vised variations that continued into the 
Second World War. According to the 
official Regulations, the army allotted 




.AVirj.,n;,iis(j;;^tv>iV.-f'">,''7V-k:K 



forty litters for every thousand troops 
in areas where two-wheeled carriages 
proved inappropriate or were unavail- 
able. These litters consisted of two 
poles, constructed in sections extend- 
ing sixteen feet in length and con- 
nected to a canvas bed. 

Both travoises and litters were used 
following the Battle of Little Big Horn. 
The army transported nineteen se- 
verely wounded soldiers on two-mule 
litters, ten on travoises, and thirty on 
horseback. Four men attended each 
mule litter, one leading the forward 
mule, one the rear mule, and one on 
either side of the litter to steady its 
swaying movement. In spite of those 
precautions, the mules recovered from 
General Custer's pack team were skit- 
tish, and on at least one occasion 
threw a wounded soldier from his 
litter.^^ 

Overall, the military relied on the 
travois more than the two-mule litter 
because of its easier construction, les- 
ser manpower need, and the frequent 
unavailability of poles for carrying the 



Wounded soldier conveyed 
on a double-mule litter 

(Courtesy of California State 
University, Long Beach) 



23 



CADUCEUS 



wounded. In rough terrain, soldiers 
carried the ends of the travois over ob- 
structions while allowing it to drag 
over smooth ground. As an added 
benefit, weakened patients had less 
chance of falling from the supports. 

The McElderry single-mule litter, de- 
signed for broken country, was used 
in actions against the Modoc in the 
lava beds of southern Oregon and 
northern California in 1872 and 1873. 
According to its inventor, Assistant Sur- 
geon H. McElderry, the litter required 
little training of mules, which was im- 
portant since the army almost always 
organized its litter trains extemporane- 
ously from pack animals released to a 
medical officer. 

Despite efforts to introduce cacolets 
in the western service. Surgeon John 
Moore recalled that troops generally re- 
jected them. He remembered few in- 
stances of their actual use; rarely were 
soldiers so removed from ambulance 
wagons or wheeled supply vehicles 
that they were willing to use the litter 
or cacolet. 

The United States Cavalry was 
equally resistant. Efforts to provide 
horsemen with the Rooker saddle at- 
tachment (designed by W. B. Rooker) 
proved hopelessly futile. Experiments 
in 1875 and 1876 in Wyoming and the 
Dakotas failed to elicit support of ei- 
ther officers or men. Although the 
army provided Rooker saddle attach- 
ments at Fort Brown, Texas, at Fort Lar- 
amie, Wyoming, and at Fort Leaven- 
worth, Kansas (as well as with army 
expeditions in Arizona and Utah), sol- 
diers preferred to carry as little bag- 
gage as possible and, in treating their 




wounded or sick, found their own 
extemporaneous methods preferable 
to the Rooker. 

Medicine Wagons 

During the early months of the Civil 
War and in the western service, the 
Union Army typically transported its 
medicines in ordinary supply or ambu- 
lance wagons and in panniers (bas- 
kets) carried by pack animals. Not 
until March, 1862, did Surgeon Jona- 
than Letterman provide specifications 
for a special medicine wagon. Eventu- 
ally the army provided each brigade 
with a wagon furnished with stores, 
dressings, furniture, appliances, and 
an amputating table. Exemplary of the 
various types of wagons used in the 
Civil War were Dunton's regimental 
medicine wagon, proposed in Novem- 
ber, 1862, which opened on the sides 
to dispense medicines, and the Perot 
medicine wagon. The Autenrieth med- 
icine wagon, recommended by the 



Left, McElderry's Single-Mule 
Litter 

Center, Rooker's saddle 
attachment packed to a 
McClellan saddle 

Bottom, Rooker's saddle 
attachment 

(Courtesy of California State 
University, Long Beach) 



24 



AUTUMN 1991 



Medical Board of Surgeons C. H. Crane, 
R. O. Abbott, and Charles Sutherland, 
was constructed by the government 
shops and adopted during the last year 
of the war. 

The need for more rapid transport 
became apparent during the Indian 
wars when emergencies faced by such 
small forces as scouting parties requir- 
ed ambulance and medical assistance 
without the encumbrance of the larger 
wagons designed for brigades. In the 
Powder River expedition against the 
Sioux in 1876, for example, the army 
carried medical supplies on two pack 
mules. Standard supplies consisted of 
a valise of surgical instruments, dress- 
ings, and chlorofomi; a medicine pan- 
nier; two cases holding twelve blankets 
each; a rubber bedcover; and bottles 
of brandy. Additional materials in- 
cluded an amputating knife, ball for- 
ceps, artery forceps, and beef extract. 

The army also authorized the con- 
struction of a one-horse, two-wheeled 
transport cart for hospital supplies. 
The Watervliet Arsenal in West Troy 
constructed the cart and delivered it to 
the Surgeon General's Office in Wash- 
ington in January, 1876. The cart car- 
ried three chests designed to hold 
surgical instruments, medicines, hospi- 
tal stores, mess furniture, and utensils. 
Each chest consisted of fitted trays con- 
taining spaces and compartments for 
individual appliances and medicines. 
The medical transport cart became an 
important addition to field army 
equipment. 

Through the first three quarters of 
the nineteenth century, ambulance 
technology and organization labored 




to keep pace with the needs of the mil- 
itary. During those years, the industrial 
revolution acted as a catalyst to inven- 
tors and manufacturers as they sought 
to make the best of the mule- and 
horse-driven conveyances and the 
newer locomotive. In large measure, 
however, ambulance and evacuation 
systems were dictated by the battle- 
field. Despite available alternatives, 
the army in the field consistently opted 
for the lightest, quickest, and least 
cumbersome contrivance — the 
stretcher. 

Ambulance technology remained 
relatively stable within the parame- 
ters of accepted warfare until small- 
arms technology and long-range 
artillery took on such dimensions of 
destructtive power as to challenge ex- 
isting evacuation systems. 



Autenrieth medicine wagon 

(Courtesy of California State 
University, Long Beach) 



25 



CADUCEUS 



Although strategists at the turn of 
the century predicted that armies 
would fight future wars with weapons 
too destructive to allow immediate re- 
lief for the wounded, most medical 
planners were unable to suggest sup- 
port and evacuation systems other 
than aid "at the first practicable mo- 
ment." Generally, military planners 
recognized that larger fighting forces 
would become embroiled in future 
wars; that wounded might lie unat- 
tended during a battle; and that, in 
order to save lives, assistance would re- 
quire haste and efficiency when the 
fighting ended. Nevertheless, few plan- 
ners considered meeting these emer- 
gencies with anything but more 
conveyances and additional volun- 
teers. Although they willingly experi- 
mented with new techniques, not until 
the development of the motorized am- 
bulance did armies finally discover an 
effective alternative to the prevailing 
medical evacuation system. 




ivj^. 



'''''^?%a, >^:*^=^ir^' 



Medicine panniers carried on 
a horse 

(Courtesy of California State 
University, Long Beach) 



26 



AUTUMN 1991 



Notes 



1. Larrey quoted in George A. Otis, A 
Report to the Surgeon General on the Trans- 
port of Sick and Wounded by Pack Ani- 
mals (Washingion. D.C.: Government 
Printing Office, 1877), p. 2. 

2. Thomas Longmore, "Ambulance," 
Encyclopaedia Britaunica; A Dictionary of 
Arts. Sciences and General Literature, 9th 
ed. (1875), 1:665. 

3. Katherine T. Barkley, "The History 
of the Ambulance," Proceedings of the In- 
ternational Congress of the History of Medi- 
cine (London, 1974), p. 457; Longmore, A 
Treatise on the Transport of Sick and 
Wounded Troops (London: W. Clowes and 
Sons, 1869), pp. 27-28; James D. Edgar, 
"Baron Larrey, The Medical Officer," Mili- 
tary Surgeon 59 (1926): 293. 

4. James H. Dible, Napoleon's Surgeon 
(London: William Heinemann, 1970), pp. 
1-18. 

5. David M. Vess, Medical Revolution 
in France, 7 7SS>-i79(S(Gainesville: Univer- 
sity Presses of Florida, 1975), pp. 79-80; 
Charies Smart, "Transportation of 
Wounded in War," Proceedings of the Asso- 
ciation of Military Surgeons of the United 
StatesA (1894): 24-25; Albert A. Gore, "The 
Ambulance in War; Its Rise and Progress 
Amongst Civilized Nations, " Transactions 
of the Indian Medical Congress (1894), p. 
347; Longmore, Treatise on the Transport 
of Sick and Wounded Troops, pp. 29-31; 

M. Mostyn Bird, The Errand of Mercy: A 
History of Ambulance Work Upon the Bat- 
tlefield (London: Hutchinson and Co., 
1913), pp. 150-51. 

6. Smart, p. 25. 

7. Ibid., pp. 24-25; Surgeon Major 
George J. H. Evatt, Ambulance Organiza- 
tion, Equipmetit, and Transport (London-. 



William Clowes and Sons, 1986), p. 6; Otis, 
Report to the Surgeon General on . . . Pack 
Animals, pp. 2-3. 

8. Venant A. L. Legouest, Traite de 
chirurgie d'armee (Puns: Bailliere, 1863), 
p. 979; George Ballingall, Outlines of Mili- 
tary Surgery {Edinburgh: Adam and 
Charles Black, 1855), pp. 116-17; Gunther 
E. Rothenberg, The Art of Warfare in the 
Age of Napoleon (London: B. T. Batsford, 
1977), pp. 228-31. 

9. Gore, pp. 5A1-AS. 

10. Ibid. 

1 1 . Evatt, p. 45; "Dandies for Field Ser- 
vice," Indian Medical Gazette 5 ( 1870): 
256; Longmore, Treatise on the Transport 
of Sick and Wounded Troops, pp. 192-95; 
Ballingall, pp. 118-19. 

12. Longmore, Treatise on the Trans- 
port of Sick and Wounded, p. 97; F. H. 
Brett, "Camel Litters for the Conveyance of 
the Sick on the Line of March," India four- 
nal of Medicine and the Physical Sciences, 
n.s. 5 (1840): 150-51; Evatt, p. 60; 
Ballingall, pp. 120-21. 

13. "The Ambulance System," 
North American Review 98 (1864): 
79-82. 

14. Otis, Report to the Surgeon General 
on . . . Pack Animals, pp. 6-7; Joseph K. 
Barnes, The Medical and Surgical History/ 
of the War of the Rebellion (Washington, 
D.C.: Government Printing Office, 1870- 
1883), Part III, 2:927; Miller J. Stewart, Mov- 
ing the Wounded: Litters, Cacolets and 
Ambulance Wagons. U.S. Army, 1 776- 
iS76(Fort Collins, Colo.: Old Army Press, 
1979), p. 26. 

15. Otis, Report to the Surgeon General 
on . . . Pack Animals, pp. 9-10. 

16. Barnes, Part III, 2:931. 



CADUCEUS 



17. Ibid. 

18. Ignaz]. Neudorkr, Handbuch der 
Kriegschirurgie (Leipzig: Vogel, 1864- 
1867), p. 341; Otis, Report to the Surgeon 
General on . . . Pack Animals, p. 3; Gore, 
p. 350. 

19. Richard Delafield, Report on the Art 
of War in Europe in 1854, 1855 and 1856. 
By Major Richard Delafield, Corps of Engi- 
neers, from His Notes and Observations 
Made as a Member of a "Military Commis- 
sion to the Theatre of War in Europe, " 
Under the Orders of the Hon . Jefferson 
Davis, Secretary of War (Washington, D.C.: 
George W. Bowman, I860), p. 73. 

20. Valery Havard, "On Stretchers and 
Stretcher Drill," Transactions of the Ninth 
International Medical Congress (Washing- 
ton, D.C., 1887), 2:56; Barnes, Part III, 
2:923; T. H. Squire, "Transportation of the 
Wounded from the Field of Battle," Boston 
Medical and Surgical foumal 72 (1861): 
152. 

21. James P. Kimball, "Transportation 
of the Wounded in War," Albany Medical 
Annals 19 (189S): 1195-96. 

22. John H. Plumridge, Hospital Ships 
and Ambulance Traitis (London: Seeley, 
Service and Co., 1975), p. 86; Otis, A Re- 
port on a Plan for Transporting Wounded 
Soldiers by Railway in Time of War, With 
Descriptions of Various Methods Employed 
for this Purpose on Different Occasions 
(Washington, D.C.: War Department, Sur- 
geon General's Office, 1875), pp. 27-28, 31. 

23. G. H. Daiwin, "The Different Meth- 
ods of Lifting and Carrying the Sick and In- 
jured," Wood's Medical and Surgical 
Monographs! (1890): 371, 374-75; J. H. 
Porter, "Some Remarks on Aid to the Sick 
and Wounded in Time of War," Lancet 2 
(1876): 529-30. 

24. Longmore, "Report on the Fitness 
for Use in the British Service of a Wheeled 
Ambulance Transport Conveyance," Army 



Medical Department Report (London, 
1865), 7:505. 

25. Larrey, Memoires de chirurgie 
militaire, et campagnes, 4 vols. (Paris: J. 
Smith, 1812-1817), l:l68; Porter, pp. 529- 
30; Alejandro Ross, "The Mexican Wheeled 
Stretcher for the Transport of Wounded on 
the Battlefield," Military Surgeon 24 
(1909): 227-34. 

26. Longmore, "Report on the Fitness . 
. . of a Wheeled Ambulance," pp. 505-14. 

27. Ibid., pp. 505, 509, 513-14; Ross, 
pp. 227-34. 

28. Barnes, Part III, 2:948; Smart, p. 40; 
Barkley, p. 458; Frank Hastings Hamilton, 
A Practical Treatise on Military Surgery 
and Hygiene (He'^ York: Bailliere Broth- 
ers, 1861 ), pp. 166-67; Longmore, Treatise 
on the Transport of Sick and Wounded, 
pp. 358-59. 

29. Barnes, Part III, 2:947-48. 

30. Ibid., pp. 949-50; Stewart, pp. 107- 
8; George W. Adair, "Wheeled Vehicles for 
the Transportation of Wounded," Proceed- 
ings of the Association of Military Surgeons 
of the United States 6 (1896): 146-51. 

31. J. D. Glennan, "The U.S. Army Am- 
bulance — Its Advantages and Defects as 
Shown by Actual Service," Proceedings of 
the Association of Military Surgeons of the 
United States A (1894): 69-70; James W. 
Wengert, "The 1878 Ambulance Board," 
Militar)' Collector and Historian 37 (1985- 
1986): 8. 

32. Barnes, Part III, 2:955-56. 

33. Stewart, p. 36; Horace H. Cunning- 
ham, Doctors in Gray: The Confederate 
Medical Sen'ice (Balon Rouge: Louisiana 
State University Press, 1958), pp. 115-20. 

34. Wengert, pp. 22, 50-67; Smart, p. 
70. 

35. Otis, Report on a Plan for Transport- 
ing Wounded Soldiers by Railway, p. 5; 
Plumridge, p. 83; Smart, p. 44; Evatt, pp. 
89-90; Russell F. Weigley, History of the 
Ufiited States Army (New York: Macmillan 



28 



AUTUMN 1991 



Co., 1967), pp. 222-25; John E. Ransom, 
"The Development of Ambulance Service 
in the Armies of Great Britain, the United 
States and Other Countries," Ciba Sympo- 
sia 8 (1946): 554-59; Mary C. Gillett, The 
Army Medical Department, 1818-1865 
(Washington, D.C.: Center for Military His- 
tory, 1987), pp. 293-95. 

36. Cyril Falls, The Art of War From the 
Age of Napoleon to the Present Day (New 
York: Oxford University Press, 1961), pp. 
66-67. 

37. Otis, Report on a Plan for Transport- 
ing Wounded Soldiers by Railway, p. 4. 

38. Louis W. Read, "Railway Transporta- 
tion of Sick and Wounded," Proceedings of 
the Association of Military Surgeons of the 
United StatesA (1894): 84-90. 

39. Percy M. Ashburn, A History of the 
Medical Department of the United States 
/lrwv(Boston: Houghton Mifflin Co., 
1929), p. 81. 

40. Otis, Report on a Plan for Transport- 
ing Wounded Soldiers by Railway pp. 11- 
12; Barnes, Part I, Appendix, p. 289; Read, 
p. 87. 

41. Otis, Report on a Plan for Transport- 
ing Wounded Soldiers by Railway pp. 7-8; 
Read, p. 86. 

42. Otis, Report on a Plan for Transport- 
ing Wounded Soldiers by Railway, pp. 16- 
17; DeForest WiUard, Ambulance Sennce 

in Philadelphia {Phihdelphii: n.p., 1883), 
pp. 19-20; Barnes, Part III, Vol. 2, Ch. 15. 

43. Hamilton, p. 168. 

44. Henry McElderry, Descriptions of 
the Models of Hospital Cars, from the U.S. 
Army Medical Museum, Washington, D.C. 
(New Orleans: World's Industrial and Cot- 
ton Centennial Exposition, 1884-1885), pp. 
4-5; Otis, Report on a Plan for Transport- 
ing Wounded Soldiers by Railway, pp. 13, 
16-17; United States Government, Interna- 
tional Exhibition of 1876. Hospital of Med- 
ical Departmetit, United States Army. 
Description of the Models of Hospital Cars 



(Washington, D.C: Government Printing 
Office, 1876), pp. 4-5; Harvey E. Brown, 
The Medical Department of the United 
States Army from 1775 to i573 (Washing- 
ton, D.C: Surgeon General's Office, 1873), 
p. 236. 

45. Otis, Report on a Plan for Transport- 
ing Wounded Soldiers by Railway, p. 7. 

46. Ibid., p. 22; Charles J. Stille, History 
of the United States Sanitary Commission; 
Being the General Report of Its Work Dur- 
ing the War of the Rebellion (Philadelphia; 
J.B. Lippincott and Co., 1866), pp. 163-65. 

47. Ashburn, p. 81. 

48. Quoted from John Van R. Hoff, 
"The Travois — A New Sanitary Appliance 
in the First Line of Battlefield Assistance," 
Proceedings of the Association of Military 
Surgeons of the United States A (1894): 89; 
Otis, Report on a Plan for Transporting 
Wounded Soldiers by Railway, p. 23; John 
S. Chisolm, A Manual of Military Surgery, 
for the Use of Surgeons in the Confederate 
/l/wy(Charleston: Evans and Cogswell, 
1861), Ch. Ill and pp. 99-106; Cunning- 
ham, pp. 122-23. 

49. Quoted from Willard, p. 17; Hoff, p. 
89. 

50. Francis Parkman, Histoty of the Con- 
spiracy ofPontiac and the War of the 
North American Tribes Against the English 
Colonies After the Conquest of Canada 
(Boston: Little and Brown, 1851), p. 601; 
Parkman, California and Oregon Trail: 
Being Sketches ofPraine and Rocky Moun- 
tain life (New York: Putnam, 1849), p. 
165; Paul Allen, Histo)y of the Expedition 
Under the Command of Captains Lewis 
a)id Clark, to the Sources of the Missouri, 
Thence Across the Rocky Mountains and 
Down the River Columbia to the Pacific 
Ocean. Performed During the Years 1804- 
5-6, by Order of the Government of the 
United States (PYiW-a^deXphix. Bradford and 
Inskeep, 1817), 2:381; Drake W. Will, "The 
Medical and Surgical Practice of the Lewis 



29 



CADUCEUS 



and Clark Expedition, " ed. Gert H. Brieger, 
Theory and Practice in American Medicine 
(New York: Science History Publications, 
1976), pp. 124-48; Otis, Report to the Sur- 
geon General on . . . Pack Animals, p. 11. 

51. William B. Lord and Thomas 
Baines, Shifts and Expedients of Camp Life. 
Travel a)id Exploration (London: Sheldon, 
1871), p. 217; Otis, Report to the Surgeon 
Gejieral on . . . Pack Animals, pp. 4-5; 
Randolph Marcy, The Prairie Traveler. A 
Handbook for Overland Expeditions ( New 
York: Harper and Brothers, 1859), pp. 150- 
54. 

52. Hoff, pp. 73-75, 78-82; Stewart, pp. 
63-64. 

53. Otis, Report to the Surgeon General 
on . . . Pack Animals, pp. 18-20; William 
E. Strong, A Trip to the Yellowstone Na- 
tional Park, in July. August, and Septem- 
ber, i§75( Washington, D.C.: n.p., 1876), 
p. 75; Charles Albert Sewall, "The New Ex- 
temporaneous Litter, Copied After the Mo- 
jave Indian Method of Carrying the 
Wounded," Medical Record!?, ( 1890): 461- 
62. 

54. Otis, Report to the Surgeon General 
on . . . Pack Animals, pp. 5-6; Marcia 
Brace Kimball, A Soldier-Doctor of Our 
Army: James P. KimbalKBoslon-. 
Houghton Mifflin Co., 1917), pp. 27-93. 

55. Otis, Report to the Surgeon General 
on . . . Pack Animals, p. 23. 

56. Ibid, pp. 15-16. 

57. Ibid., p. II. 

58. Ibid., p. 13. 

59. Barnes, Part III, 2:917-19. 

60. Otis, Report to the Surgeon General 
on . . . Pack Animals, p. 19. 

61. David L. Huntington and Otis, Hos- 
pital of Medical Department, United States 
Army. No. 6. Description of the U.S. Army 
Medical Transport Cart. Model of 1876 
(Philadelphia: International Exhibition, 
1876), pp. 3-16. 



62. James P. Kimball, p. 202; Adair, pp. 
146-51. 



John S. Haller, Jr., is Professor of History 
at Souttiern Illinois University at Carbon- 
dale as well as Professor of Medical Hu- 
manities at the Southern Illinois University 
School of Medicine. This essay has been 
adapted from his Farmcarts to Fords: A 
History of the Military Ambulance, 1793- 
1 925, to be published in 1992 by Southern Il- 
linois University Press. 



30 



AUTUMN 1991 



An Introduction to the Medical 
Museums Association Symposium 



In 1989 the officers of the Medical 
Museums Association (MeMA) re- 
sponded to new challenges by setting 
an ambitious education agenda for its 
member institutions. As expressed by 
President James M. Edmonson in the 
May, 1989, issue of lATROS: A Newslet- 
ter from the Historical Divisiou of the 
Cleveland Health Sciences Library. 

The medical workplace has its 
own special set of risks, rang- 
ing from radiation and lethal 
drugs to the spectre of bacte- 
rial and viral infection. While 
we readily acknowledge that 
there are very real dangers in 
these varied workplaces, who 
would think that medical his- 
tory museums shared such po- 
tential risks? Not many, I 
suppose, and yet it is true. . . . 
I am concerned that very real 
risks to health lie hidden or 
unrecognized in collections of 
medical artifacts. . . . 
Fellow medical museum cura- 
tors, as well as collectors of 
medical antiquities, share my 
concerns about our ability to 
recognize and deal with po- 
tential health hazards in muse- 
ums and private collections of 
medical objects. 



Three important concerns were 
identified: ( 1 ) Effective but nondestruc- 
tive sterilization procedures for medi- 
cal instruments and artifacts; (2) 
Radiation hazards from radium-con- 
taining medical devices and scientific 
instruments; and (3) Curatorial and 
safety challenges posed by drugs and 
chemicals. 

Those crucial issues were discussed 
at the first joint programming of MeMA 
and the Association of Librarians of 
History and Health Sciences, held at 
the Sixty-Fourth Annual Meeting of the 
American Association for the History 
of Medicine. The resulting sympo- 
sium, "Potential Health Hazards in 
Medical Museums," brought together 
the following four health sciences ex- 
perts. 



CADUCEUS 



Sterilizing Surgical Instruments: 
A Curator's Historical Perspective 



Let me explain how I became inter- 
ested in the subject of sterilizing his- 
toric surgical instalments. How many 
medical museum people — curators, 
registrars, and collections specialists — 
have ever cut themselves with a surgi- 
cal instrtmient? It has happened to me 
a few times, none of them exceptional. 
Only once did I really panic. In 1983 I 
managed to slice my hand on a micro- 
tome in the Physiology Department at 
the School of Medicine of Case West- 
ern Reserve University. Two things dis- 
tinguish microtomes from most other 
laboratory apparatus: While they are 
not especially large, they are ex- 
tremely heavy and have exposed 
blades that are razor-sharp. While fum- 
bling, trying to pick up the microtome, 
I inadvertently brushed against the 
blade. When I cut myself, I could feel 
the blood drain from my face. Remem- 
ber, in 1983 public knowledge about 
AIDS and its transmission was still 
pretty aidimentary. There I was, in a 
medical environment, cut by the blade 
of an instrument designed for mount- 
ing pathology specimens. I knew that 
it hadn't been used for some time, but 
alarming thoughts crept into my mind 
nonetheless. Could it be contami- 
nated? Could I be infected? Panic just 
swept over me. Later I tried to laugh 



off the experience, chalking it up as 
just another of those strange predica- 
ments in which medical museum cura- 
tors occasionally find themselves. 

Sometime later I encountered an- 
other circumstance, not involving self- 
inflicted wounds but one in which a 
museum curator was concerned about 
transmission of infections via old surgi- 
cal instruments. At the time, I was visit- 
ing the Eckley Miners' Museum, a 
restored mine "patch" near Hazleton 
that is now operated as an open-air 
museum by the Pennsylvania Histori- 
cal and Museum Commission. The 
Eckley collection included many medi- 
cal instruments, reflecting the presence 
of a succession of company doctors 
who served this remote mining com- 
munity. The curator routinely steri- 
lized the instruments in basins full of 
disinfectant solutions. The instru- 
ments were "old," and it occurred to 
me that some of them weren't going to 
fare too well soaking in those solu- 
tions. Also, the curator had taken to 
wearing rubber gloves. I was amused 
at this, thinking that if she really 
wanted her fingers to be safe among 
those sharp instruments she should 
have been wearing chain mail gloves, 
not just those latex ones. Rather than 
dismiss her concerns, however, I 



by James M. Edmonson 



32 



AUTUMN 1991 



realized that she was facing unfamiliar 
dangers that needed to be addressed. 

We should know a lot more about 
the nature of the hazard posed by sur- 
gical instruments in historical collec- 
tions. We need to determine how to 
contend with problems that we can 
identify, while at the same time inflict- 
ing no harm upon the artifacts in ques- 
tion. I don't think that we are 
anywhere near the point of having all 
the answers, but I hope that we are 
now taking the right steps toward that 
end. 

In this instance, history can be very 
instructive. Just about one hundred 
years ago surgeons and physicians 
were preoccupied with the steriliza- 
tion of instalments. Their efforts cul- 
minated in the mixed 
antiseptic-aseptic surgical protocol that 
survives in great measure today. 
There is no single event to observe or 
mark this centennial, however. The 
development of antisepsis and asepsis 
transpired over three decades, with 
their triumph occurring around 1893. 
I want to review these changes, with 
particular emphasis on how our medi- 
cal forebears resolved the problem of 
instrument sterilization. 

Louis Pasteur's enunciation of the 
germ theory in the early 1860s initiated 
thirty years of ferment and change. 
During that period surgeons had to 
modify their procedures and instai- 
mentation to accommodate the new 
understanding of disease. Application 
of the germ theory to surgery began 
with Joseph Lister in 1865. Lister 
learned of germ theory almost seren- 
dipitously from a chemistry colleague. 



,,, ^.^ ^^ *'^]^i 



Professor Thomas Anderson of the Uni- 
versity of Glasgow. When Lister devel- 
oped his system of antiseptic surgery 
he placed great emphasis on disinfec- 
tants, chiefly carbolic acid. He may 
have derived that idea from the con- 
temporary practice of using carbolic 
acid, or phenol, at sewage farms near 
Carlisle, England." 



This photograph, taken 
about 1886, shows David 
Hayes Agnew performing 
antiseptic surgery. 

(Courtesy of the Hagley 
Museum and Library) 



33 



CADUCEUS 



By March of 1865 Lister began using 
wound dressings soaked in carbolic 
acid; two years later, in April of 1867, 
he devised the "antiseptic curtain," a 
carbolic-soaked lint held over the oper- 
ating field. By 1869 Lister introduced 
the antiseptic spray, with a steam-pow- 
ered version coming into use by 1872. 
These apparatus were on the market 
in the 1870s and their use continued 
well into the 1880s, as is demonstrated 
by the photograph of David Hayes 
Agnew's surgical clinic in Philadelphia. 

The Agnew photograph, dated 
1886, is an especially intriguing docu- 
mentation of the practice of antiseptic 
surgery. The assistant seated in the 
foreground directs the carbolic acid 
sprayer over the patient's wounded 
limb, while Agnew conducts the clinic. 
The scene represents just about the 
last gasp, if you will, of "Listerism." By 
the time of the 1886 photograph, anti- 
septic surgery had become a very elab- 
orate affair that included not only the 
dressings and spray, but also the wash- 
ing of hands and the soaking of instru- 
ments in carbolic acid. Some surgeons 
balked at the complication of such pre- 
cautions, while others were dismayed 
at the effect of carbolic acid upon their 
instruments — not to mention their 
hands, eyes, and respiratory system. 

By 1889 Agnew had abandoned 
Lister's antisepsis in favor of asepsis, 
which depended chiefly upon the 
eradication of infection by heat. 
Painter Thomas Eakins documented 
the shift dramatically in his famous 
1889 painting, "The Agnew Clinic." By 
that year Agnew and his surgical staff 
had donned white surgical garb and 



had dispensed with the spray appara- 
tus. On a table nearby were instru- 
ments soaking in some solution, 
perhaps still carbolic acid. The instru- 
ments had changed, too. Now they 
were all metal, rather than ebony- or 
ivory-handled. 

The reason for the change in the 
form and materials of instrument han- 
dles is well illustrated by an artifact in 
the Dittrick Museum — an amputating 
knife with a severely deformed han- 
dle. An accompanying note from the 
donor. Dr. Abraham Groves of Fergus, 
Ontario, explains the circumstances in 
which such damage occurred. Groves 
informed Howard Dittrick in 1932: 
"The condition of the handle was 
caused by boiling. I boiled all instal- 
ments, sponges and dressings to be 
used in operating and I began this July 
5th 1873- Previous to that date I never 
heard this was done."" 

Groves considered himself a pio- 
neer in surgical asepsis, at least in On- 
tario, and offered this instrument as 
proof. His precaution of boiling cer- 
tainly helped kill germs, but his instru- 
ments suffered mightily in the process. 
Boiling and other forms of sterilization 
by heat would ultimately supplant 
many disinfectants, including carbolic 
acid. The change not only would im- 
prove the chances of achieving a ster- 
ile condition but would also compel a 
complete transformation of surgical in- 
struments. The older variants, like 
those of Dr. Groves, would not survive 
the change. 

Killing microorganisms by heat was 
not as novel as Groves supposed. 
Louis Pasteur advocated the practice. 



34 



AUTUMN 1991 



which has since been eponymically 
termed "pasteurization." Pasteur, who 
was not initially inclined to speak out 
on the medical implications of his re- 
search, eventually overcame his reluc- 
tance. In his celebrated lecture to the 
Academic de medecine in April of 
1878, Pasteur specifically recom- 
mended sterilization by heat: 

If I had the honour of being a 
surgeon, convinced as I am of 
the dangers caused by the 
germs of microbes scattered 
on the surface of every object, 
particularly in hospitals, not 
only would I use absolutely 
clean instalments, but, after 
cleansing my hands with the 
greatest care and putting them 
quickly through a flame (an 
easy thing to do with a little 
practice), I would only make 
use of charpie, bandages, and 
sponges which had previously 
been raised to a heat of 130 
degrees C. to 150 degrees C; I 
would only employ water 
which had been heated to a 
temperature of 110 degrees C. 
to 120 degrees C. 

Pasteur and Charles Chamberland, 
his research assistant, developed hot- 
air sterilizers for their research, and in 
1881 Chamberland devised an auto- 
clave similar in principle to Papin's 
pressure cooker. John J. Perkins, au- 
thor of a standard modern treatise on 
sterilization, contended that 
Chamberland's autoclave "must be 
considered as the father' of our mod- 





ern precision sterilizers."^ By 1887 the 
Chamberland autoclave was adapted 
for clinical use by P. Redard and manu- 
factured by both Luer and Wiesnegg in 
Paris. Instmments would be sterilized 
for fifteen to twenty minutes at 1 10 de- 
grees Centigrade. 

In Germany, meanwhile, Pasteur's 
rival Robert Koch and his colleagues 
also experimented to determine the 
temperatures required to kill microor- 
ganisms. In the process, they devised 
both hot-air and steam sterilizers that 



Left, "Autoclave de 
Chamberland" 

Right, "Autoclave du docteur 
Redard, " from an 1893 
surgery manual 

(Both courtesy of the Dittrick 
Museum of Medical History) 



35 



CADUCEUS 



would be adopted by eariy German 
proponents of asepsis. Schimmelbusch, 
assistant to tlie surgeon von Bergmann, 
began using steam to sterilize dress- 
ings in 1885. By 1888 von Bergmann 
routinely autoclaved all surgical materi- 
als and boiled instruments in a 20% 
soda solution to reduce n.ist spotting. 
The codification of aseptic surgical pro- 
tocol took place in their clinics during 
the late 1880s, and the resulting array 
of sterilisers appears in Schimmelbusch's 
1893 work, Anleitimg ziir aseptischen 
Wundbehandlung, or "Instructions for 
aseptic wound treatment." 

The adoption of sterilizers and auto- 
claves in America took place in two 
phases shortly after those develop- 
ments. The first sterilizers were intro- 
duced for removing organic or 
infectious matter from milk containers 
and feeding vessels, and only later 
were they adapted to meet surgical 
needs. For example, the Arnold steril- 
izer was patented in the early 1880s 
for the purpose of sterilizing bottles; it 
was manufactured by Wilmot Castle & 
Co. of Rochester, New York. An adver- 
tisement for it appeared in the Truax, 
Greene & Co. instrument catalogue of 
1893, along with a distinctly medical 
version for sterilizing surgical instru- 
ments. 

The second phase of sterilizer and 
autoclave diffusion came in the mid- 
1890s, when the Sprague sterilizer ap- 
peared on the medical scene. Austin 
V. M. Sprague, a businessman and in- 
ventor from Rochester, first devised 
steam laundry machinery and then 
saw that it might be adapted for clean- 
ing and disinfecting instruments and 




Three turn-of-the-century 
sterilizers. Clockwise, from 
bottom, a special instru- 
ments sterilizer, Robert 
Koch's model, and the 
Arnold. 

(All courtesy of the Dittrick 
Museum of Medical History) 



36 



AUTUMN 1991 



dressings. The production and distri- 
bution of the Sprague sterilizer was un- 
dertaken by Richard Kny, a New York 
City manufacturer of instruments and 
hospital supplies, with Sprague becom- 
ing manager of Kny's "department of 
apparatus for sterilization and disinfec- 
tion." Kny's enterprise, subse- 
quently known as the Kny-Scheerer 
Company, marketed the Sprague steril- 
izer effectively throughout the net- 
work of American hospitals. In its 1902 
Catalogue of Modem Hospital Sup- 
plies, Kny-Sheerer listed the names of 
more than three hundred hospitals that 
had installed its sterilizers and auto- 
claves. 

The widespread adoption of auto- 
claves meant that traditional instru- 
ments and materials, the kind that 
medical museum curators value, 
would quickly pass from the scene. In 
their place came chromium-plated and 
stainless-steel-ailoy instruments that 
endured the temperature extremes 
called for by aseptic protocol. The 
challenge facing today's medical mu- 
seum is to determine which of the cur- 
rent sterilization techniques is 
appropriate for both older, fragile arti- 
facts and newer, less vulnerable ones. 
Some of the autoclaves and sterilizers 
devised a century ago would be ser- 
viceable, undoubtedly, for some 
classes of artifacts. The variety of 
methods available is quite extensive, 
however, offering many more options, 
but the procedures employed in each 
technique are very exacting. Those of 
us charged with the care of medical 
collections must defer to persons expe- 
rienced in the use of today's sterilizing 



practices. The difficulty lies in finding 
a qualified person who is also sensi- 
tive to the particular concerns of the 
museum curator. 

The overriding concern of a 
hospital's central service, where instru- 
ments are sterilized, is achieving com- 
plete asepsis; worries about the effect 
of such techniques are secondary. 
When curators confront the question 
of sterilizing instruments, they are com- 
pelled to address both concerns with 
equal weight. 



37 



CADUCEUS 



Notes 



1 . See James M. Edmonson, "Asepsis 
and the Transformation of Surgical Instru- 
ments," Transactions & Studies of the Col- 
lege of Physicians of Philadelphia, ser. 5, 
vol. 13 (1991): 75-91, and John Kirkup, 
"Thermal Sterilization and the Surgical In- 
strument Revolution," forthcoming from 
the Belgian Medical History Society. 

2. This point illustrates that antisepsis 
was not something restricted solely to clini- 
cal medicine; public health concerns rein- 
forced it and promoted its spread. See F. 

F. Cartwright, "Antiseptic Surgery," in Medi- 
cine and Science in the 1860s, ed. F. N. L. 
Poynter, Proceedings of the Sixth British 
Congress on the History of Medicine, Uni- 
versity of Sussex, 6-9 September. 1967 (Lon- 
don: Wellcome Institute of the History of 
Medicine, 1978), p. 91. 

3. Groves to Dittrick, Accession File 
#2612, the Dittrick Museum of Medical His- 
tory, Cleveland. 

4. Rene Vallery-Radot, 77ie Life of Pas- 
teur, trans. Mrs. R. L. Devonshire (London: 
Constable and Co., 1923), p. 274. 

5. Felix Terrier and M. Peraire, Petit 
manuel d'antisepsie &d'asepsie 
chinirgicales (Pzns: Ancienne librairie Ber- 
mer Bailliere et Cie., 1893X pp. 91-92. 

6. John J. Perkins, Principles and Meth- 
ods of Sterilization in Health Sciences, 2nd 
ed. (Springfield, 111.: Charles C Thomas, 
1967), p. 11. 

7. "M. Redard. — Desinfection des in- 
struments chirurgicaux et des objets de 
pansement. Rapport de M. Just Lucas- 
Championniere," Revue de chirurgiel 
(1887): 412; R. Redard, "De la desinfection 
des instruments chirurgicaux et des objets 
de pansement. "Revue de chirurgie 8 
(1888): 360-71, 494-509. 



8. Koch's hot-air sterilizer is featured 
in F. & M. Lauenschlager, Preis-ver- 
zeichttiss uber bacteriologische, 
microscopische und uroscopische Apparate 
und Instrumente (Berlin, n.d.), p. 29. 

9. C. Schimmelbusch, Anleitung zur 
aseptischen Wundbehandlung (Berlin: ver- 
lag von August Hirschwald, 1893), espe- 
cially Ch. 4, "Sterilisation der 
Metallinstrumente." 

10. Chas. Truax, Greene & Co., Price 
List of Physicians' Supplies, 6th ed. (Chi- 
cago: Chas. Truax, Greene & Co., 1893), 
pp. 840-41. 

1 1 . Richard Kny & Co. , Descriptive Cat- 
alogue No. 3 of Aseptic Furniture, Operat- 
ing Tables, Sterilizing Apparatus and 
Sick-room Utensils Manufactured by Rich- 
ard Kny & Co. (New York: Richard Kny & 
Co., 1896), pp. 147-52. 

12. Kny-Scheerer Co., Catalogue of 
Modem Hospital Supplies Wew York: Kny 
ScheererCo., 1902), pp. 264-65. 



James M. Edmonson is Curator of the 
Dittrick Museum of Medical History and a 
Past President of the Medical Museums 
Association. Among current projects, he is 
co-editing a collection of essays in the field 
of medical museology and is compiling a 
directory of seventeenth- and eighteenth- 
century surgical instrument makers. 



38 



AUTUMN 1991 



Decontamination and Sterilization of 
Medical Instruments in Museums 



Traditionally, museum curators 
have not been charged with the re- 
sponsibility for removal of microbes 
from their collections. Nor has there 
been a criterion that medical instru- 
ments must be cleaned and sterilized 
before accessioning. Today, however, 
because of concerns about the spread 
of disease due to blood-borne patho- 
gens, medical museum professionals 
are looking to institutional health care 
professionals for guidance in cleaning, 
disinfection, and sterilization of medi- 
cal artifacts. 

Our questions are the same: (1) 
What has been the microbiological en- 
vironment surrounding the instrumen- 
tation? (2) What if any organic material 
is present on each instrument? (3) Are 
any of the microorganisms potentially 
harmful to staff? (4) What material is 
each instnmient made from, and how 
does that material limit our cleaning or 
sterilization options? 

It is very apparent that universal pre- 
cautions have had a dramatic impact 
on procedures and products for use in 
health care facilities. From a variety 
of procedures and products, each insti- 
tution — whether hospital or medical 
museum — can establish an effective 
protocol for instrument decontamina- 
tion and sterilization. 



Cleaning Protocol 

Cleaning is defined as removal of 
adherent visible soil (that may be con- 
ducive to the continued growth of mi- 
crobes) from surfaces, crevices, 
serrations, joints, and lumens (cavities) 
of instruments, devices, and equip- 
ment." In health care facilities we se- 
lect from five basic cleaning protocols: 
presoaking, manual cleaning, ultra- 
sonic cleaning, washer decontamina- 
tion units, and point-of-use cleaning 
and disinfection." 

Presoaking is placing the soiled in- 
stalment into plain water, enzyme 
cleaners, or water-and-detergent solu- 
tion without mechanical agitation. Pre- 
soaking can not only prevent drying of 
blood and organic soil but also can re- 
move dried blood and soils already on 
the instamient (see Presoaking Table). 

In Diaiiual cleaning, a worker prop- 
erly attired in protective clothing (in- 
cluding haircovering, goggles, mask, 
coversuit, and gloves) places the items 
to be cleaned into a sink or basin con- 
taining the prescribed dilution of de- 
tergent and then scrubs each item with 
a brush under the water level. The 
items are rinsed by spraying or under 



by Eleanor Reilly 



39 



CADUCEUS 



Presoaking Solutions 




Solutions Advantages 


Disadvantages 


Cold Water Keeps blood and other soils moist 


Not effective in softening or 
removing dried soils 


Detergent Keeps soils moist wtiile loosening 
previously dried on soils 


IVIechanical friction is also needed 
to completely remove soils 


Disinfectant-Detergent Keeps soils moist while softening 
previously dried soils. Also, may 
reduce the level of microorganisms 
on instruments. 


May give personnel a false 
sense of security for disinfection. 
In order to achieve proper 
disinfection, the surface must be 
cleaned first. 


Enzyme Effective in removing dried and 
moistened soils without any 
mechanical action needed 


Cleaning efficiency depends 
on enzyme concentration, use 
temperature, and contact time 


Source: Sandra Harrison, William Evans, Destin LeBlanc, and Lee Bush, " 
Instruments," Journal of Healthcare Materiel Management, January 1990 


Cleaning and Decontaminating Medical 



direct running water. Finally they are 
towel or aired dried. 

Ultrasonic cleaners remove residual 
soil in a matter of minutes. Ultrasonic 
cleaners have acoustic frequencies 
above the range audible to the human 
ear (above 20,000 cycles per second). 
They are comprised of a precision elec- 
tronic generator (which converts 50 or 
60 Hz alternating electric current to the 
desired frequency), a tranducerized 
tank filled with water and a cleaning 
solution, and perhaps additional 
heater boosters, spray rinse tanks, and 
other attachments. 

The generator supplies oscillating 
electric voltage to the tranducer, 
thereby inducing sound waves into the 
cleaning solution and producing a bub- 
ble formation known as cavitation, 
which actually compresses and decom- 
presses the solution. During the low- 
pressure cycle tiny bubbles are 



created, then collapse — or implode — 
in the high pressure of the next half 
cycle. The violence of the implosion 
shock wave dislodges soil from the sur- 
face of the instrument. 

For effective ultrasonic cleaning, all 
instruments must be in the open posi- 
tion, with all removable parts disassem- 
bled; any instalment with a hollow 
core must be filled with cleaning solu- 
tion. Solution temperatures in ultra- 
sonic cleaners range from 110 to 130 
degrees Fahrenheit. The ideal temper- 
ature is the one at which the chemical 
effect is greatest; the cleaning solution 
cavitates most powerfully; the items 
will not be damaged; and the soil 
(such as blood) will not be "heat set." 

Washer decontamination umXs, 
clean by a spray-force action (or im- 
pingement) in several successive 
steps: cold water rinse, detergent 
wash, rinse, and dry. The detergent 



40 



AUTUMN 1991 



solution is applied under pressure 
through nozzles on fixed or rotating 
arms inside the unit. The final rinse 
usually consists of dionized or soft- 
ened water. 

Point-of-iise cleaning and disinfec- 
tion is an option for heat-labile instai- 
mentation (especially flexible 
endoscopes) that cannot be steam ster- 
ilized. Point-of-use cleaning is by ei- 
ther an enzyme or a detergent 
formulation, followed by disinfection 
with activated glutaraldehyde. It is 
very important that the detergent be 
thoroughly rinsed off or a white spot- 
ting problem may occur. ' 

Instrumentation Lubrication 

Even after the most careful and thor- 
ough cleaning process an instrument 
can be stiff and hard to work. Or, min- 
eral deposits and other impurities from 
the water supply can cause .staining, 
rusting, and corrosion. Water-soluble 
lubricants applied to instruments prior 
to drying can prevent such problems. 
Most lubricants contain a nist-inhibit- 
ing agent useful in the prevention of 
electrolysis on points and edges. Be- 
cause instmment lubricant is water sol- 
uble, it penetrates into all crevices and 
will not interfere with any sterilization 
process. 

Chemical Cleaning Processes 

Just as soil can be water soluble or 
insoluble, organic or inorganic, chemi- 
cal cleaning agents have a wide range 
of properties and uses. Choosing a 



chemical cleaning process is a balance 
between risk assessment (including 
risks to personnel) and cost effective- 
ness. No single cleaning agent can re- 
move all types of soil. 

Chemicals can be used in the fol- 
lowing processes: (1) Emulsification 
of fats by suspending them in water; 
(2) Saponification of fats by making 
them water soluble; (3) Surfaction, or 
lowering surface tension of the water; 
(4) Dispersion, or breaking up of soil 
into small particles; (5) Suspension, or 
keeping insoluble particles of soil sus- 
pended in the water; (6) Peptizing, or 
breaking up proteins; (7) Water soften- 
ing to remove calcium and magnesium 
ions by rendering them insoluble. 

In choosing chemical cleaners for 
medical instruments, it is important to 
consider material compatibility with 
the cleaning product. Special consider- 
ation must be given to items contain- 
ing .stainless steel, titanium, gold or 
chrome plating, tungsten carbide in- 
serts, plastic, and rubber. Compatibil- 
ity data should be supplied by the 
chemical manufacturer. 

Cleaning Solutions 

Enzymes are organic substances 
that affect a specific chemical action. 
Specific enzymes are usually active on 
specific soils, such as protease in help- 
ing to break down proteinaceous soils. 
Because enzymes are usually fomiulated 
with a surfactant to improve wetting 
and penetration into dried soil resi- 
dues, they are typically used as soak- 
ing solutions. Enzymes are effective in 
removing soils without mechanical 



CADUCEUS 



action and are therefore recom- 
mended for cleaning sensitive pieces 
like lumens and endoscopes. 

Manual cleaners are generally sur- 
factant solutions sold as concentrate 
liquids and used in sinks as a presoak 
agent for a variety of material, includ- 
ing metals and plastics. Manual clean- 
ing formulations are generally at a 
neutral pH of 7-9. Read the direc- 
tions carefully for the correct use dilu- 
tion. Manual cleaners should be used 
with some kind of mechanical action, 
such as a soft bristle brush. 

Ultrasonic cleaning solutions are 
low-foaming liquids designed specific- 
ally for ultrasonic cleaners. The solu- 
tions are normally formulated with 
both surfactants ( for wetting and re- 
moving soil) and suspending agents 
(which help prevent soils from rede- 
positing on instruments as they are re- 
moved from the tank). Ultrasonic 
products vary from neutral pH to alka- 
line. 

Washer decontamination solutions 
are also liquid products offered in a 
wide range of pH and alkalinity levels. 
The pH is usually in the 7-9 range. 
Washer decontamination solutions are 
composed of nonionic surfactants and 
suspending/dispersing agents. They 
are generally safe for metal, plastic, 
and aluminum, but the higher the pH 
and alkalinity levels the more damag- 
ing and corrosive these solutions can 
be. 

Disinfectant/cletergentscomh'me 
surfactants and antimicrobial agents. 



Their primary purpose is to reduce the 
bioburden ( number of microorga- 
nisms.) on instruments. Their cleaning 
ability is not as good as products made 
for that purpose. Disinfected instru- 
ments must be thoroughly rinsed, and 
disinfectant solutions are not suitable 
for ultrasonic or washer decontamina- 
tion units due to foaming. The three 
most common types of disinfectant so- 
lutions are quats, phenolics, and glutar- 
aldehydes. Quats and phenolics are 
used for disinfecting during the earlier 
stages of cleaning, while glutaralde- 
hydes are generally used for terminal 
chemical disinfection and are not good 
detergents. Quats and phenolics 
should be limited to quality stainless 

steel items because of their ability to 

9 
cause corrosion on other metals. 

Acid cleaners are usually phospho- 
ric acid-based products that remove 
rust deposits from instruments but do 
not stop active corrosion sites. Con- 
tact time with acid products should be 
strictly monitored so further damage is 
not done to the metal surface. Hydro- 
chloric acid or hydrochloric acid nist 
remover should never be used on 
stainless instruments and may be dan- 
gerous for the chromium oxide layer 
of any surface. 

Sterilizing Processes 

Sterilizing an item involves killing 
all living microorganisms as well as 
any dormant spores. Since all forms of 
sterilization are intended to kill living 
organisms, sterilizing agents and equip- 
ment can be hazardous to personnel. 



42 



AUTUMN 1991 



There are three essential conditions for 
sterilization: ( 1 ) Both temperature and 
sterilant concentration must be at le- 
thal level for microorganisms; (2) The 
bioburden must be sufficiently low- 
ered through cleaning to insure the ef- 
fectiveness of sterilization — the higher 
the bioburden, the more difficult it is 
to kill microbes; (3) There must be ade- 
quate contact of the sterilant, for suffi- 
cient time, with all surfaces of the 

10 

Item. 

The four types of sterilization used 
in health care settings today are steam 
sterilization, ethylene oxide steriliza- 
tion, dry heat sterilization, and chemi- 
cal sterilization. Successful 
sterilization depends not only on the 
proper design and operation of the 
sterilizer, but also on how the items 
are packaged and loaded into the ster- 
ilizer. 

Saturated steam underpressure is 
the most economical and reliable 
method. Steam sterilization is used for 
almost all metal items, most rubber 
goods, surgical trays, fabric packs, 
glassware, and some hard plastic 
items. Steam sterilization is more eas- 
ily controlled, less expensive, and gen- 
erally less hazardous to personnel than 
other sterilization methods. 

Steam sterilization occurs in a 
closed chamber and is based on direct 
steam contact with all surfaces as well 
as each thread, fiber, or particle of po- 
rous materials. The steam must be hot 
enough (250 - 275 degrees Fahren- 
heit) to destroy all microbes in the 
time allotted for sterilization. The tem- 
perature of the steam is controlled by 



increasing the pressure in the closed 
chamber (28-32 pounds per square 
inch). 

Ethylene oxide is a chemical vapor 
process well suited for instruments 
that are sensitive to heat or moisture. 
With an effective sterilant temperature 
range of 90 to 140 degrees Fahrenheit 
and pressures of 10 to 15 pounds per 
square inch, ethelyne oxide is noncor- 
rosive and nondamaging to plastics 
and rubber. It is commonly used to 
sterilize microsurgery instruments, 
electrical equipment, anesthesia equip- 
ment, cardiac catheters and endo- 
scopes, and other lensed items. 

Ethylene oxide sterilization is con- 
siderably more expensive than steam, 
however, and poses potential health 
hazards for personnel. The process 
takes between seventeen and sixty 
hours, including exposure and aera- 
tion periods. Ethylene oxide in its 
pure form is extremely flammable as 
well as toxic; insufficient aeration time 
can result in serious danger to person- 
nel. The Occupational Safety and 
Health Administration (OSHA) has des- 
ignated ethylene oxide as a potential 
carcinogen. 

Dr)' heat sterilization is intended 
for items that are anhydrous (i.e., con- 
tain no moisture), including petroleum 
jelly, oils, powders, and some needles. 
In emergencies, metal instaimentation 
can be sterilized by this method. 

Chemical sterilization is accom- 
plished by complete immersion of 
items in a commercial sterilization 



43 



CADUCEUS 



solution, commonly glutaraldehyde 
and fomialin. Because of the difficulty 
of maintaining the sterility of an item 
when rinsing off the sterilant solution 
and transferring the item to its point of 
use, chemical sterilization is not used 
extensively in health care settings but 
may be appropriate for museum items 
intended for display, provided person- 
nel observe rigid federal guidelines. 

OSHA strictly regulates occupa- 
tional exposure to toxic chemicals. 
Under its Hazard Communication Stan- 
dard, OSHA also requires manufactur- 
ers of toxic chemicals to provide users 
with Material Safety Data Sheets 
(MSDS). Employers are required by 
law to assure compliance by imple- 
menting engineering controls, defining 
procedures for safe employee work 
practices, establishing medical surveil- 
lance programs, and the like. Limits 
on occupational exposure to chemical 
agents are commonly defined in terms 
of the maximum amount of chemical 
to which an employee can be exposed 
over a particular period of time. 

Many states and local communities 
impose additional safety, health, and 
"right to know" standards for the use 
and disposal of chemical sterilants. It 
is the obligation of the user to be 
aware of all state and local regulations. 

When using chemical sterilants, per- 
sonnel should avoid direct contact. 
Protective attire, adequate ventilation 
to prevent inhalation, and a hood are 
essential. 

Among new sterilization systems 
are ozone, hydrogen peroxide vapor, 
plasma sterilization, peracetic acid, 
and chlorine dioxide gas. Bulk medi- 



cal supplies can be sterilized in a com- 
mercial setting by electron beam and 
gamma radiation. 

Conclusion 

Many museum pieces are very old, 
fragile, and made of such precious ma- 
terials as mother of pearl, ivory, and 
wood. These substances cannot be 
subjected to many of the processes de- 
scribed above. Leather bags and 
cases, for example, can only be scrub- 
bed with saddle soap and perhaps fu- 
migated with processes similar to 
those used by libraries on books. 

Curators must choose from among 
several processes to clean, disinfect, 
and sterilize the instruments in their 
collections. The available processes 
are intricate, specific, and regulated by 
governmental agencies. Curators of 
medical museums are advised to seek 
guidance from the sterile processing 
department of the local hospital for as- 
sistance in preserving and maintaining 
medical artifacts in their collections. 



AUTUMN 1991 



Notes 



1. "C.D.C. Update: Universal Precau- 
tions for Prevention of Transmission of 
Human Immunodeficiency Virus, Hepatitis 
B Virus, and Other Blood Borne Pathogens 
in Health Care Settings," MMWR^l ( 1988): 
377 - 88. 

2. Peggy Ryan, "Concepts of Clean- 
ing Technology and Processes," Journal of 
Healthcare Materiel Management, Novem- 
ber - December 1987, pp. 21 - 27. 

3. Sandra Harrison, William Evans, 
Destin LeBlanc, and Lee Bush, "Cleaning 
and Decontaminating Medical Instru- 
ments, "./oMrwa/o/Z/efl/f^careyWa/ene/ 
Management ]3.nu-ivy 1990, pp. 36-42. 

4. John J. Perkins, Principles and 
Methods of Sterilization in Health Sciences, 
2nd ed. (Springfield, 111.: Charies C 
Thomas, 1967). 

5. Marion Detwiler, "Ultrasonic Clean- 
ing in the HospivA," Journal of Healthcare 
Materiel Manageineyit, April 1989. pp. 46- 
49. 

6. William Rutala, "APIC Guidelines 
for Selection and Use of Disinfectants," 
American Journal of Infection Control, 
April 1990. 

7. Detwiler, pp. 46 - 49. 

8. Harrison et al., pp. 36 - 42. 

9. Rutala. 

10. Training Manual for Central Ser- 
vice Technicians (ChicAgo: Society for 
Health Care Central Service Personnel, 
1986), pp. 139 - 66. 

11. "Chemical Sterilants and Steriliza- 
tion Methods: A Guide to Selection and 
Use," in Technical Information Repo>-t of 
the Association for the Advancement of 
Medical Instrumentation, March 1990. 

12. Ibid. 



Eleanor Reilly has completed her thirtieth 
year as Manager of the Central Service De- 
partment of the Cleveland Clinic Founda- 
tion. Among many other professional 
responsibilities, she serves as Vice-Chair- 
man of the National Institute for Certifica- 
tion of Sterile Processing Personnel. She 
earned the B.S.N, degree at St. John Col- 
lege of Cleveland. 



45 



CADUCEUS 



RADIUM RENTAL FEE SCHEDULE 


RADIUM 


14 


1-1 ',4 


2-2 !4 


J-3'4 
Days 


t.'av't 


S-6'A 


6-e'i 


7-7 Si 
Daya 


10 mg3. 


? 9.00 


$10.00 


$20.00 


$25.00 


$30.00 


$35.00 


$40.00 


$45.00 


25 mgs. 


20.00 


25.00 


40.00 


50.00 


60.00 


70.00 


80.00 


90.00 


50 mgs. 


30.00 


35.00 


60.00 


75.00 


90.00 


105.00 


120.00 


135.00 


75 mgs. 


45.00 


50.00 


85.00 


105.00 


125.00 


145.00 


165.00 


185.00 


100 mgs. 


55.00 


GO.OO 


100.00 


125.00 


150.00 


175.00 


200.00 


225.00 


A Radium Day ...d. a. mij„igl.t and Radium MUST La .en. for re.ur,, before .l.at hour .f an 
addu.onal day's rental charge is to be avoided. Example: <jRad.un, delivered lo you «( 10.00 a. 
m. Monday, and ma.led for re.urn to us at 10:00 p n.. Tuesday, .s ONE (1) days rental- if sent for 
return at 10:00 a. m, Wednesday, it is TWO (2) day's rental. W.ll. tl.e one day rental fee, how- 
ever, tl.e pl.ys.cian may reta.n tl.e Radium in l.is posesslon 36 hoUFS, regardless of the hour of receipt. 

The al.ove fees are <juole,l on a strictly CBsh baSIB. 



The X-Ray and Radium 
Laboratories of Quincy, 
Illinois, offered supervised 
radium rentals to physicians. 
These prices were in force for 
the month of October, 1929. 
This brochure is part of the 
Health Physics Historical In- 
strumentation Museum 
Collection of Oak Ridge 
Associated Universities. 



AUTUMN 1991 



Radioactive and Radium Sources in 
Medical Museums 



For health practitioners in the first 
half of the century, the primary attrac- 
tion of radium was its amazing ability 
to kill off tumors. Although radioac- 
tive cures and devises constitute a fas- 
cinating and colorful chapter of 
medical history, they should not be 
considered merely icons of a bygone 
era. They pose ongoing and serious 
risks for the museum curator who 
chooses to collect them. 

PARTI 

Atoms and Nuclides 

Any discussion of radioactive mate- 
rials must begin with an explanation of 
the basic building block of matter — 
the atom. An atom almost always con- 
sists of electrons orbiting about a 
nucleus made up of neutrons and pro- 
tons. The exception is the hydrogen 
atom, which usually consists of a sin- 
gle electron orbiting about a nucleus 
consisting of a solitary proton. 

Atoms can be sorted into nuclides, 
a nuclide being a group of atoms 
whose nuclei possess the same num- 
ber of neutrons and protons. For ex- 
ample, the nuclide carbon-12 consists 
of atoms whose nuclei possess six pro- 
tons and six neutrons. Carbon- 13 nu- 
clei possess six protons and seven 




Each half-ounce bottle of 
Radlthor contained one mi- 
crocurie each of radium-226 
and radium-228. 

(All photos in this article are 
courtesy of Oak Ridge 
Associated Universities.) 



RADITHOB 

REC. V. S. TAT. C!>- 

Radioactive Wa'^ 

"■adiumandMc-'f^' 
'n Triple Disti'.K'^ ^' 



neutrons. Carbon-l4 nuclei possess 
six protons and eight neutrons. Some 
nuclides are are stable (eg., C-12 and 
C-13), while others (e.g., C-14) are un- 
stable. The latter are referred to as ra- 
dionuclides, and they all have one 
thing in common — they decay. 

Radioactive Decay 

When a radionuclide decays it 
changes into another nuclide possess- 
ing a more stable combination of neu- 
trons and protons. During the decay 



by Paul W. Frame 



47 



CADUCEUS 



process, energy is released and a small 
particle is emitted. At least some of 
the released energy is given to the par- 
ticle in the form of kinetic energy. 
Sometimes a portion of the energy is 
also emitted in the form of gamma 
rays. The two most common types of 
particles emitted during decay are beta 
and alpha particles. 

Beta particles are electrons ejected 
from the nucleus. They can travel sev- 
eral feet in air but are usually stopped 
completely by 1/4 inch of glass or plas- 
tic. If radioactive material is kept in a 
bottle or other type of container, there 
is little danger from the betas — they 
cannot penetrate the walls of the con- 
tainer. If, on the other hand, the radio- 
active material (i.e., the radionuclide 
itself) gets out of the container, it can 
be inhaled or ingested. And once the 
material is inside the body, the beta 
particles emitted in the decay process 
will deposit their energy in the body's 
tissue. The resulting damage will de- 
pend primarily on the energy of the 
beta particles and the sensitivity of the 
tissue absorbing that energy. 

Alpha particles are helium nuclei 
(two protons and two neutrons) 
ejected from larger nuclei. They are 
even less penetrating than betas and 
can be completely stopped by a piece 
of paper. Plutonium is often said to be 
the most hazardous material on earth, 
yet large quantities can be safely held; 
the alpha radiation emitted by pluto- 
nium cannot penetrate the dead layer 
of skin on your hands. Even when in- 
gested, it can be less hazardous than 
the same amount of caffeine because 
the latter is readily assimilated by the 



body whereas plutonium is not. On 
the other hand, extremely small quanti- 
ties can be highly toxic if they enter 
the body through inhalation. As a 
rule, alpha emitters inside the body are 
more hazardous than beta emitters. 
The reason is twofold. First, alpha par- 
ticles usually have more energy than 
beta particles. Second, they deposit 
their energy in the body in a more con- 
centrated or localized way. 

Gamma rays, being electromagnetic 
radiation, are another story. They are 
highly penetrating. A substantial 
amount of shielding, usually lead, is re- 
quired to stop them. As such, radionu- 
clides emitting gamma rays can be a 
hazard even if located outside the 
body. 

Radium-226 

The radionuclide that will be of 
most concern in medical museums is 
radium-226. It is by no means the only 
radionuclide that has been used in 
medicine, but it is the one most fre- 
quently used in the early days. It also 
possesses a rather unique combination 
of undesirable characteristics. 

Because it has a very long half-life — 
sixteen hundred years — radium loses 
little of its activity over time. A radium 
source today is as hazardous as it was 
fifty years ago. Radium is also readily 
absorbed by the body. Being chemi- 
cally similar to calcium, it will concen- 
trate in the bones. Following decay, 
radium-226 atoms are converted into 
radionuclides called daughters or prog- 
eny. Collectively, radium-226 and the 
daughters (with which it is always 




The Lifetime Radium 
Vitalizer was an aluminum Jar 
containing uranium ore. 



48 



AUTUMN 1991 



found) emit alpha, beta, and gamma 
radiation. Radium therefore poses a 
potential hazard whether found inside 
the body or in a sealed capsule outside 
of it. Radioactive material like radium 
does have one virtue, however, it is ex- 
tremely easy to locate — something that 
cannot be said for most chemical or bi- 
ological hazards. 

Radium Sources in Medicine 

The amount of radium is usually ex- 
pressed in millicuries or milligrams. 
One millicurie is 37 million decays per 
second. One milligram of radium-226 
equals one millicurie. 

From 1900 to 1930, radium sources 
that would be placed in or on tumors 
typically contained up to 100 
millicuries — an astounding amount. 
After 1930, the quantities tended to be 
smaller but still substantial, one to ten 
millicuries. Even so, a few medical fa- 
cilities continued to use what were re- 
ferred to as "bombs," which were 
sources of one to ten curies! One 
gram of radium-226 is approximately 
one curie of activity, and therefore one 
milligram equals one millicurie. By 
definition, one curie is 37 billion (37 x 
10 ) decays per second. 

Purifying enough radium for these 
sources was quite expensive because 
of the tremendous quantities of ura- 
nium ore required. Physicians there- 
fore considered radium sources quite 
valuable, and most state radiation con- 
trol officials can tell stories of finding 
radium-226 sources in bank vaults or 
safety deposit boxes. I recently heard 
of radium-226 sources being discov- 



ered under the bed of an individual 
who had received them as part of an 
inheritance! 

Of the various types of radium 
sources, needles were the most com- 
mon. As the name implies, they resem- 
bled the common sewing needle, with 
a point at one end and an eyelet at the 
other. After being threaded with a silk 
string to aid in their removal, the nee- 
dles were inserted directly into the 
tumor. Typical needles were 2 to 6 
cm. long and 0.2 cm. in diameter. 
Most often they were made of a plati- 
num iridium alloy, although they some- 
times had a gold sheath. Bent or 
broken needles posed serious health 
hazards. 

There was a minor improvement in 
later designs, when the radium was en- 
capsulated in one to three cells (ca. 0.1 
X 1 cm. each), which were placed in 
the needle. If the needle broke, the ra- 
dium might still be safely contained in- 
side the cells. 

Radium tubes were similar to the 
needles except larger in diameter and 
rounded at both ends. As a rule, they 
were not inserted directly into tumors 
but were placed in a body cavity or 
used in conjunction with a mould or 
other form of applicator that was 
placed on the tumor. 

Radium plaques were small-area 
sources, often about 1 cm. x 1 cm., 
that were placed on top of tumors or 
diseased tissue (usually skin). Typical 
activities ranged from ten to twenty 
millicuries. Unlike needles and tubes 
(which relied on the emitted gammas 
to kill the tumor), the plaques were 
lightly shielded utilizing the emitted 



49 



CADUCEUS 



beta radiation. Beta therapy, and 
therefore the use of plaques, became 
less common after 1930. 

Radon seeds were manufactured by 
sealing approximately one millicurie 
of radon-222 (a radioactive gas pro- 
duced by the decay of radium-226) in 
small gold tubes (approximately 0.3 to 
0.5 cm. in length and 0.1 cm. in diame- 
ter) called seeds. The seeds could be 
implanted permanently in the tumor 
because radon-222 has a relatively 
short half-life, 3.8 days, which is long 
enough for the seeds to deliver the re- 
quired dose to the tumor but short 
enough for the radioactivity to disap- 
pear after a couple of months. An- 
other advantage was the flexibility of 
the technique: One radium source 
could be used to produce many radon 
seeds of varying strengths. 

Applicators were devices into 
which radium sources might be 
placed. The applicators took all kinds 
of shapes and were made of clay, 
metal, wood, or plastic. They were po- 
sitioned on the tumors or inserted into 
a body cavity (usually the mouth or 
uterus). Moulds, as the name implies, 
were applicators individually formed 
to fit a particular patient. Normally ap- 
plicators are not radioactive unless a 
source was inadvertently left inside or 
contamination occurred from a leaking 



Leakage of Radium Source 

The primary concern associated 
with radium sources is leakage — es- 
cape of radioactive material from its 
encapsulation. Unfortunately, leakage 




is not uncommon. Early radium 
sources, especially needles, were eas- 
ily bent or broken. Even in the ab- 
sence of mechanical damage, such 
sources are prone to leaking because 
of the build-up of pressure inside the 
source created by the emission of 
alpha particles. Because alpha parti- 
cles are helium nuclei, an accumula- 
tion of helium gas inevitably occurs 
inside sealed alpha-emitting sources. 
In the event of a leak, one of two 
things happens. Either only the radio- 
active decay products (or daughters) 



The Radium Emanator con- 
sisted of five stackable 
plates containing uranium 
ore. As stiown on the pacl<- 
age label, it fit neatly in a 
water cooler. 



50 



AUTUMN 1991 



of radium escape, or the radium as 
well as its decay products escapes. 

Radium is a solid, but when it de- 
cays it becomes radon-222, a radioac- 
tive gas with a half-life of 3-8 days. 
Even if damage to the source does not 
cause the radium itself to leak out, the 
radon gas might. The gas can then 
spread, and as it decays, it will pro- 
duce radioactive polonium-218, 
polonium-214, lead-214 and bismuth- 
214 — all of which are solids. Those ra- 
dionuclides attach to particulates in 
the air and then settle out on such sur- 
faces as walls, floors, and countertops. 
In some cases, they will be inhaled be- 
fore settling out. If radon is detected, 
it can be dealt with fairly easily be seal- 
ing the radium source in a secondary 
container that prevents any further re- 
lease to the air. The radioactive con- 
tamination on the walls, floors, tables, 
or whatever will decay away in a few 
days. 

The hazard associated with radon is 
the increased risk of lung cancer 
brought about by the inhaled radon 
decay products. The magnitude of the 
risk depends upon the amount of 
radon escaping, the ventilation system 
of the building, and the occupancy of 
the affected areas. There is also evi- 
dence that the increased risk of lung 
cancer due to radon exposure is 
greater for smokers than nonsmokers. 

Much more serious is a source leak 
involving radium-226. Although seal- 
ing the source in another container 
halts the further release of radioactive 
material, the escaped radium must be 
located and disposed of. Locating ra- 
dium is generally easy to do, but if po- 



rous materials like wood or leather 
have been contaminated they also 
must be disposed of, regardless of any 
historic importance such material 
might possess. 

The major concern with a leaking 
radium source is the possibility that 
some of the radium may be ingested 
or inhaled. In either case, the radium 
will be readily absorbed by the body 
and will accumulate in the skeleton. 
The result is irreversible, an increased 
risk of cancer, especially leukemia. 

Preventative Measures for Medical 
Museums 

Radium is extremely toxic, and 
medical applications usually involved 
large quantities of it. Radium sources 
used in medicine were often prone to 
developing leaks. In addition to the 
health concerns, leaking radium 
sources can endanger an entire collec- 
tion. 

In the United States, approximately 
twenty percent of the population will 
eventually develop and die of cancer. 
This means that there will be a very 
good chance that someone who is ex- 
posed to contamination from a leaking 
source will develop cancer. While the 
cancer in the vast majority of cases 
would not be related to the exposure, 
the individual developing the cancer 
or their relatives might very well think 
otherwise. The result may be a lawsuit. 

Recommended Procedures 

Conducting a survey for radioac- 
tive material. Surveys should be 



CADUCEUS 



made by a professional health physi- 
cist or radiation safety officer. The 
state radiation control program may be 
able to supply one, or assistance can 
be sought from the safety offices of 
universities or hospitals. 

Disposing of radium sources. The 
historical importance of a radium-con- 
taining device should be considered 
secondary to the health and safety 
issue. 

Disposal of radium sources must be 
done in accordance with the applica- 
ble federal and state requirements. Be 
sure to contact the state radiation con- 
trol program. At the very least they 
will provide the infomiation necessary 
to dispose of the sources legally. They 
may, in some cases, actually assist in 
the disposal. 

Monitoring incoming donations. 
In addition to inspections by radiation 
experts, museums might consider pur- 
chasing an inexpensive Geiger-Mueller 
(GM) detector for times when other 
help is not available. An additional 
"check" source is required to insure 
that the detector is working properly. 

PART II 

Radioactive Quack Cures 

For thousands of years, mankind 
has been absolutely convinced that the 
waters at certain health springs and 
baths possessed near-miraculous cura- 
tive properties. With the discovery at 
the turn of the century that the waters 
were often radioactive, a scientific ex- 
planation became available — the cures 




were due to radioactivity, specifically 
the dissolved radon. Promoters 
claimed that radon was to water what 
oxygen was to air — the very stuff of 
life. Water without radon was consid- 
ered dead. 

Very quickly, a host of companies 
developed radium-containing devices 
for adding radon to water. The items 
described below are all from the collec- 
tion at Oak Ridge Associated Universi- 
ties. 

The Revigator was a water jar made 
from radium-containing ore. Water 
placed in the jar would accumulate 
radon produced by the decay of the ra- 
dium. The Revigator thus eliminated 
the need for an expensive and time- 
consuming pilgrimage to some far dis- 
tant health spring. It provided the 
owner's household with a perpetual 
supply of radioactive water. Between 
the years 1915 and 1935, more than 
100,000 were sold. 



Radio-Active Solar Pad, with 
suggestions for wearing 



52 



AUTUMH1991 



The Lifetime Radium Vitalizer, an 
aluminum jar, was manufactured 
sometime around 1925. Like tfie Revig- 
ator, it added radon to drintcing water. 
It actually contained uranium ore. 

"Emanators" were small radon-emit- 
ting devices tfiat could be placed in 
drinking water. The Thomas Cone, 
manufactured at about the same time 
as the Revigator, was a six-inch con- 
crete cone containing about seventy 
grams of uranium ore. The smaller 
Zimmer Radon Generator (first known 
as the Zimmer Radium Emanator) was 
metallic, operating on the same princi- 
ple. Approximately ten thousand 
were manufactured between 1930 and 
the late 1940s. 

It is not surprising that the Ameri- 
can Medical Association was quite con- 
cerned about such devices, but it may 
be surprising to us today that the AMA 
was primarily interested in establishing 
minimum standards of radioactivity. 
AMA guidelines in effect until 1929 re- 
quired that an emanator produce 
radon concentrations in water at or 
above specific minimum levels if it 
was to receive AMA approval. 

The Radium Emanator was built by 
Radium Life Inc. sometime between 
1925 and 1930. An extremely unique 
device, it consisted of five uranium- 
containing concrete plates stacked one 
on top of another. The large surface 
area guaranteed enhanced emission of 
radon, and the number of plates could 
be reduced to permit a gradual reduc- 
tion in the strength of the emanations 
as a cure progressed. 

Radithor was a radium-containing 
drink produced from 1925 to 1935. It 



would have been a good thing had 
this been a fraudulent product contain- 
ing no radium. It was not, however, 
for it fully delivered its claim of at least 
one microcurie each of radium-226 
and radium-228 per half-ounce bottle. 
Excessive use of Radithor can be 
linked to at least a couple of deaths — 
the most notable being that of Eben 
Byers, United States amateur golf 
champion and president of Byers' 
Steel, who died in 1932 from consum- 
ing four bottles a day for two years. 
Byers, like Radithor producer William 
Bailey, primarily used the product be- 
cause he believed it a potent aphrodis- 
iac. But numerous other claims for the 
product were also made. As an exam- 
ple, the promotional brochure for 
Radithor included the following testi- 
monial as proof of the product's ability 
to cure neurasthenia. 

NEURASTHENIA 
Male, age 42, married. Man- 
ager of Co-operative Store. 
This patient felt no longer 
equal to the exacting tasks of 
his position and wanted to 
quit to take up manual labor. 
It is self-evident that when a 
man wants to lay down the 
pen to pick up the shovel he 
is slipping. This man has 
taken Radithor for five months 
and will continue to take it for 
perhaps another five months. 
He is still on the job despite 
the fact that his responsibili- 
ties have increased rather than 
decreased. 

—Dr. N.A.F. 



53 



CADUCEUS 



Degnen's Standard Radio-Active 
Solar Pad was produced by the Ra- 
dium Appliance Company in the 
1920s. The manufacturer recom- 
mended that it be charged in sunlight 
for enhanced radioactivity. For a bad 
back, the pad was tied around the af- 
fected area; for respiratory ailments, it 
was placed over the lungs. The com- 
pany also produced the Radio-Active 
Sta-Put Truss, the Radio-A Cerebro Spi- 
nal Pad, and a variety of similar de- 
vices. 

The Ionic Charger, a more modern 
device for enhancing water, was pro- 
duced in the 1960s. The charger con- 
sisted of a radium source located 
inside a shielded cylinder and a series 
of tubes and bulbs that transmitted 
radon (or, the "life element") to a 
drinking glass. The manufacturer, the 
Ionic Research Foundation, main- 
tained that such water would benefit 
plants and animals as well as humans. 

The NAC (nicotine alkaloid control) 
plate is a completely modern device, 
manufactured in the late 1980s in 
Japan. (Someone is currently trying to 
get permission to produce it in this 
country.) The NAC is the size of a 
credit card, and one side is covered 
with low-grade uranium ore. It is 
meant to be placed in a package of cig- 
arettes, where the emitted radiation 
will "destroy and denature" harmful el- 
ements in the cigarette without affect- 
ing the smooth tobacco flavor. 

Hundreds of similar devices have 
been produced over the years, and 
many are offered to medical museums. 
Some contain virtually no radioactive 
material, but most contain a little. A 




few — such as Radithor and the Ionic 
Charger — contain substantial quanti- 
ties. 

Even if the hazard posed by a de- 
vice is minimal, it is still an unneces- 
sary one. I do not advise that 
radioactive materials be collected. At 
the very least, they should be evalu- 
ated by a professional health physicist. 



Paul W. Frame is founder of ttie Health 
Physics Historical Instrumentation Museum 
Collection of Oak Ridge Associated Univer- 
sities. He is an instructor of health physics 
in the Professional Training Programs of 
that institution, as well a member of the ad- 
junct faculty of the University of Tennes- 
see. He holds an M.S. in health physics 
from the Georgia Institute of Technology 
and a Ph.D. in biology from the University 
of Toronto. He is certified by the American 
Board of Health Physics. 



The Ionic Charger, intended 
to transmit the "life element" 
to drinking water, was pro- 
duced as late as the 1960s. 



54 



AUTUMN 1991 



The Preservation and Disposition of 
Hazardous Substances and Controlled 
Drugs in Museum Collections 



Today, as in the past, drugs make 
up a large and important part of the 
therapeutic armamentarium of the 
health professions. They are being col- 
lected and preserved in order to study 
and illustrate the history of therapy 
and the development of the profession 
of pharmacy. They can be found in 
every medical museum and important 
medical collection in the world, yet 
some may pose a health hazard. Many 
invoke concern. 

Over-the-counter (OTC) medica- 
tions make up the bulk of our pharma- 
ceutical and medical collections, but 
there are also many other chemical, bo- 
tanical, and mineral substances that 
are not drugs or used in making drugs 
but may be toxic or hazardous. These 
materials, in crude or bulk form, are 
sometimes part of other objects that 
we collect, including dental and veteri- 
nary preparations, stains, laboratory re- 
agents, cosmetics, germicides, and 
pesticides. They should all be consid- 
ered together when discussing the 
preservation and disposition of hazard- 
ous and controlled substances in mu- 
seum collections. 

There are no well-established and 
widely-used procedures for the preser- 




vation and disposition of hazardous 
and controlled dmgs or substances, 
yet the topic is of great interest to mu- 
seum curators, conservators, and 
safety officers. This paper is based on 
my own experience and observations, 
discussions with colleagues, safety 
training workshops, and some limited 
research. 



Sealed reagent bottles for 
acids. The one on the right 
has a wrapper that is discol- 
ored, bulging, and forming 
crystals. If conservation 
work cannot stabilize the re- 
action, the contents should 
be removed. 

(Photos in this article are 
courtesy of the National 
Museum of American 
History.) 



by Ramunas Kondratas 



55 



CADUCEUS 



Identifying Controlled and Hazardous 
Substances 

Two questions should be consid- 
ered by all museum staff responsible 
for medical collections: (1) What haz- 
ardous drugs or other substances are 
in the collection? (2) What is currently 
being done about them? To help 
answer the first question, we need to 
identify not only substances regulated 
under existing federal law but also 
those considered most hazardous by 
occupational and industrial hygienists. 

Controlled substances are primarily 
abused substances found in illegal traf- 
fic, including narcotics, depressants, 
stimulants, cannabis, and hallucino- 
gens. The legal basis for government 
control of these substances is the Con- 
trolled Substances Act (CSA), which is 
Title II of the Comprehensive Drug 
Abuse Prevention and Control Act of 
1970. This law consolidates numerous 
older laws regulating manufacture and 
distribution of narcotics and other 
abused substances and also places 
each of the regulated substances into 
one of five schedules. Factors such as 
the substance's medical use, potential 
for abuse, and safety determine place- 
ment into each schedule. 

Schedule I substances, for example, 
are those that have a high potential for 
abuse and no accepted medical use in 
the United States. They include, 
among others, heroin, marihuana, 
LSD, peyote, and mescaline. Schedule 
II substances have a high abuse poten- 
tial with severe psychic or physical de- 
pendence liability, but may also have a 
currently accepted medical use in the 



United States. Some examples are 
opium, morphine, codeine, metha- 
done, cocaine, and amphetamines. 
Both Schedule I and Schedule II sub- 
stances must be stored in safety cabi- 
nets or drug safes. Hospital supply 
companies are a good source for this 
kind of equipment (also see the list of 
resource agencies at the end of this 
article). 

Substances in Schedules III, IV, and 
V have currently accepted medical 
uses and lesser abuse potentials. Com- 
plete lists of substances on all five 
schedules can be found in the manuals 
for pharmacists and physicians pub- 
lished by the Drug Enforcement Ad- 
ministration (DEA) of the United States 
Department of Justice, the government 
bureau responsible for regulation. An 
excellent source for the public is an- 
other DEA publication, Dnigs of Abuse. 

Among a host of hazardous sub- 
stances are corrosives, reactives, toxic 
or poisonous metals, natural plant poi- 
sons, and solvents. Corrosives are 
harsh substances that can destroy on 
contact skin, eyes, and other organs. 
Their vapors if inhaled or swallowed 
can harm internal organs. Examples of 
corrosives are sulfuric acid, hydrochlo- 
ric acid, perchloric acid, and such 
bases as lye and potassium hydroxide. 

Reactives — or "nervous" chemi- 
cals — can explode, burn, or release 
dangerous vapors. In the explosive 
category are such strong oxidizers as 
nitric acid, picric acid, and hydrogen 
peroxide. Unstable reactives include 
ether and chloroform. 

Arsenic and mercury are the toxic 
chemicals most frequently found in 



56 



AUTUMN 1991 




Containers with different 
kinds of poison labels, in- 
cluding cannabis, strychnia, 
copper sulfate, mercury, and 
belladonna 



medical collections. Mercury is pres- 
ent in instruments as well as in numer- 
ous pharmaceutical preparations. 
Mercury is highly toxic; it can be ab- 
sorbed through the skin and attack the 
nervous system. Accordingly, leakage 
or other accidents call for specially de- 
signed mercury spill kits. The Safety 
Resource Committee of the College of 
American Pathologists recommends 
that only personnel in protective 
equipment be allowed at a spill site 
and that the site be thoroughly 
ventilated. 

Natural plant poisons in pharmaceu- 
tical collections, especially of crude 
drugs and tinctures, include aconite, 
digitalis, belladonna, curare, and ipe- 
cac. Other poisons to consider are sol- 
vents that are highly toxic, especially 
benzene and carbon tetrachloride. 



Conducting a Survey of the Collection 

The first step is to read all package 
labels. Check substance contents in stan- 
dard phamiacopeias, dispensatories, and 
tbmiularies. The most helpful are recent 
editions of Tfje Merck Index, the 
Physicians' Desk Reference, and the Haz- 
cirdoi IS Chem icals Desk Refere) ice. Tliose 
volumes and others iLsted in the Bibliogra- 
phy at the end of this article offer detailed 
infomiation about each daig or chemical 
substance, including toxicity and instruc- 
tions for care and handling. 

Depending on the year of niimufac- 
aire and type of produa, some OTC and 
other coinmercial preparations may not 
list contents. A usefiil reference for deter- 
mining undisclosed ingredients, espe- 
cially of niiiny twentieth-century products, 
is Robert Gosselin's Clinical Toxicolog)' of 



57 



CADUCEUS 



Commercial Products, which lists 
about five thousand commercial prepa- 
rations by name and by chemical 
contents and percentages; toxic ingre- 
dients are starred with an asterisk. 
With Gosselin's Toxicology, it is possi- 
ble to determine the actual contents of 
such products as Bromfed Capsules, 
an antihistamine and decongestant; 
Bromi-Lotion, an antiperspirant; Bromi- 
nal Plus, a weed killer; and Brom-o- 
gas, a fumigant. 

For older products, especially those 
with Latin names — VIN. IPECAC (wine 
or fluidextract of ipecac) and TR. 
LOBELIAE (tincture of lobelia), for ex- 
ample — the old pharmacopeias, dis- 
pensatories, formularies, medical 
dictionaries, and pharmacy textbooks 
are the best published sources of infor- 
mation. The expertise of retired phar- 
macists, chemists, pharmacy school 
instructors, botanists, or drug company 
employees may also be useful for 
products that predate standard drug 
and OTC reference works. 

Each specimen must be examined 
carefully. Some labels carry printed 
warnings or drawings of a skull and 
crossbones. Packaging can also be a 
clue: some poisons were sold in spe- 
cial bottles made of brightly colored 
glass (like deep cobalt blue) or having 
distinctive ribbed or studded surfaces 
so as to be easily distinguished by 
sight or touch. 

Simply because a substance is iden- 
tified as a poison does not necessarily 
mean that it is dangerous or hazard- 
ous, however. In prescribed dosages, 
poisonous plants and metals have 
often been used in medicinal prepara- 



tions. One of the most frequently 
asked questions by visitors to the 
1890s period drugstore of the National 
Museum of American History is 
whether the contents of the bottles 
and drug jars are real — particularly, 
whether such now-illegal narcotics as 
laudanum are real. When visitors find 
out that the answer is yes, they are 
more impressed and satisfied with 
their experience. We as curators and 
educators must remember that people 
come to museums and historical collec- 
tions to see real things, in as close to 
original condition as possible. 

For that reason, every effort should 
be made to keep the contents and con- 
tainers of unique or historic items to- 
gether. Both are important. They were 
intended to be together and, if possi- 
ble, should stay together. Would we 
display a period living room without 
its furniture? Whether exhibited in 
properly secured cases or period 
rooms or stored in locked and well- 
ventilated cabinets or storage safes, 
these historic artifacts should pose no 
danger either to museum staff or the 
public. 

Conversely, unlabeled and un- 
known substances should not be 
stored or exhibited. They should be 
weeded out and considered for 
deaccession. If provenance records or 
other sources suggest that a specimen 
is historically important or unique, it 
might merit an c:)fficial laboratory analy- 
sis. Or, if the original container is 
unique or historically significant, it can 
be preserved after the contents have 
been properly disposed of. 



58 



AUTUMN 1991 



Hazardous Chemicals 

There is little rationale for preserv- 
ing hazardous chemicals in medical 
museums. Most, like corrosive sulfuric 
acid and the highly toxic solvents, are 
abundant and easily synthesized. 
They are found in laboratories and 
manufacturing plants throughout the 
world. Hazardous chemicals have no 
unique significance, but they do pose 
significant risks to museum staff, the 
public, and other objects in the collec- 
tion. Occasionally, there may be good 
reasons for preserving the original con- 
tainers, but most such chemicals were 
sold in standard stock or reagent bot- 
tles. 

Deaccession and Disposal 

If a decision is made to remove poi- 
sonous or hazardous substances from 
the collection, the curator should work 
with conservators, safety officers, and 
state authorities. Regulations of the En- 
vironmental Protection Agency, the 
DEA, and OSHA are quite specific re- 
garding disposal of poisonous and haz- 
ardous materials. In addition to the 
sources listed at the end of this article, 
local health and fire departments can 
offer valuable advice. 

When considering what to collect 
and what not to collect, what to keep 
and what to dispose of, a museum 
should be guided by its mission state- 
ment and collecting plan. If collecting 
drugs and other chemical substances is 
not within the scope of those guide- 
lines, such items should be properly 




disposed of or offered to appropriate 
institutions. 

Maintaining the Collection 

Museums should observe policies 
for proper care, storage, handling, 
preservation, and exhibiting of phar- 
maceutical and chemical artifacts. Con- 
servation manuals offer guidelines in 
some of these areas, and additional in- 
struction is available from safety train- 
ing courses offered by such organiza- 
tions as the Smithsonian Institution. 

Curators or collection managers 
should make regular visual inspections 
of drug and chemical collections. Even 
when contents of OTC preparations 
are listed on the package (or recipes 
are found in formularies), much can 
still be learned about the composition 
and stability of each item over time. In 
fact, much less is known about the 
long-term effects of combinations of 
substances than the characteristics and 
toxicity of each substance. If one notes 
frothing around corks or stoppers, 



Cobalt blue poison bottles. 
The taller bottle is ribbed, 
with the word "POISON" em- 
bossed on its panels; the 
other is studded, with "POI- 
SON" embossed on its stop- 
per. 



59 



CADUCEUS 



formation of crystals on pills or tablets, 
or discoloration of labels on contain- 
ers, immediate action is called for. A 
chemical reaction of some type is prob- 
ably occurring, and the object is being 
ruined. Specimens undergoing 
change should be given to the conser- 
vator. If they cannot be stabilized, 
they should probably be removed. 

Our experience at the National Mu- 
seum of American History has been 
that the older, cork-stoppered or glass- 
stoppered bottles tend to be very se- 
cure and stable. In fact, there are 
more problems with some OTC prod- 
ucts and packaging of the 1950s, 
1960s, and 1970s than with nineteenth- 
century ones. Recently, for example, 
we found conservation problems with 
toothpaste tubes. We do not know yet 
whether the source of the trouble is 
the metal container, some chemical in 
the paste, or a combination of the two. 
And who knows what conservation 
problems other twentieth-century ma- 
terials will present in the future? 

Common sense is always the safest 
response when confronted with seri- 
ous conservation problems or poten- 
tially hazardous materials. Some 
people panic when they see a drug in 
their collection. Their first reaction is 
to get rid of it, throw it out, flush it 
down the toilet. Think before you 
flush. Do not create an irreversible 
loss. Be cautious and prudent. There 
may be ways to stabilize the product. 
Or there may be other institutions bet- 
ter equipped to care for or interpret it. 




Conclusion 

Our primary concerns as curators, 
educators, historians, or librarians 
should be the collection, preservation, 
care, and interpretation of historical ar- 
tifacts and documents. It is our respon- 
sibility to provide the historical 
arguments and cultural meanings for 
preserving significant objects. An im- 
portant part of that mission is offering 
a longer and larger view for under- 
standing medical history and its social 
and cultural underpinnings. 

For example, narcotics and other 
substances that are now controlled 
were not always controlled. In fact, 
throughout the nineteenth and early 
twentieth centuries all of the now-con- 
trolled substances were readily avail- 
able to the public in any pharmacy in 
the United States or could be ordered 
through a supply catalog. Narcotics 
were an integral part of the medical 
and pharmaceutical practices of those 
days. 



Toothpaste tube and pack- 
age in very badly deterio- 
rated condition. Objects in 
sucti advanced stages of de- 
terioration should be dis- 
carded. 



AUTUMN 1991 



Concern about drugs was ncjt so 
much about their abuse potential or ad- 
dictive qualities but rather about their 
purity. The first Pure Food and Drugs 
Act of 1906 did not prohibit the use of 
any substance but merely mandated la- 
belling. Eventually, as there was over- 
whelming evidence of the deleterious 
medical effects of some narcotic sub- 
stances, there were gradual restric- 
tions, beginning with the Harrison 
Narcotic Act of 1914 and continuing 
with the Opium Control Act of 1942, 
the Narcotic Drug Control Act of 1956. 
and the Dn.ig Abuse Control Amend- 
ment of 1965. An excellent history of 
these developments is David Musto's 
The American Disease: Origins of Nar- 
cotic Control. 

If we as museum scholars and edu- 
cators agree that the history of drugs 
and pharmaceuticals are important 
parts of medical, social, and cultural 
history, then we should work together 
to establish guidelines for preserving 
and exhibiting them responsibly. With 
proper storage equipment, pnident 
handling practices, and precise safety 
policies, we can reconcile our interpre- 
tive and preservation goals with the 
need to assure safety to our col- 
leagues, our publics, and our collec- 
tions. Both concerns can be 
accommodated if intelligently and ra- 
tionally considered. 

Resource Agencies 

The National Museum of American His- 
tory of the Smithsonian Instution has a 
very large collection of pharmaceuticals, 
and we are willing to help answer your 



queries; write Room 5000, Medical Sci- 
ences Division, National Museum of Ameri- 
can History, Washington, DC 20560. Our 
colleagues at the following institutions can 
also offer valuable assistance: American In- 
stitute of the History of Pharmacy (Phar- 
macy Building, University of Wisconsin, 
Madison, WI 53706); History Office of the 
Food and Drug Administration (HFC-24, 
Rm 13-45, Rockville, MD 20857); and the 
Philadelphia College of Pharmacy and Sci- 
ence, especially Dr. Ara H. Der Marderos- 
ian (43rd and Woodland Ave., 
Philadelphia, PA 19104). A guide to phar- 
macy mu.seums and historical collections 
in the United States and Canada is listed in 
the Basic References section. 

A directory of conservators is available 
from the American Institute for Conserva- 
tion, 1400 l6th St. N.W., Suite 340, Wash- 
ington, DC 20036. 

Assistance in regulating exposure to 
and use of potentially hazardous chemicals 
in marking, cleaning, conserving, or pre- 
.serving collections is available from OSHA 
(Occupational Safety and Health Adminis- 
tration). The address of the OSHA Publica- 
tions Office is 200 Constitution Avenue 
N.W., Room N3101, Washington, DC 
20210, or (202) 523-9667. For OSHA re- 
gional offices, see Exposure to Hazardous 
Chemicals in Laboratories. 

Safety equipment, from gloves to mer- 
cury spill kits, is available from Lab Safety 
Supply, Inc., P.O. Box 1368,.Ianesville, WI 
53547-1368 or 1-800-356-0783. The com- 
pany maintains a 24-hour SAF-T-LINE 
(1-608-754-6040) for information about per- 
.sonal protection, .storage or handling, haz- 
ard control, proper labeling, computer 
software safety programs, and OSHA and 
EPA compliance requirements. 

Addresses and phone numbers of state 
drug abu,se prevention and treatment coor- 
dinators and for DEA division offices are in 
Drugs of Abuse. 



CADUCEUS 



Basic References 

American Pharmaceutical Association, ed. 
Handbook of Nojiprescription Drugs. 
9th ed. Washington, D.C.: American 
Pharmaceutical Association, 1990. 

Drug Enforcement Administration, U.S. De- 
partment of Justice. Drugs of Abuse. 
Washington, D.C.: Government Printing 
Office, 1988. 

Drug Enforcement Administration, U.S. De- 
partment of Justice. Pharmacist's Man- 
ual: An Informational Outline of the 
Controlled Substances Act of 1970. Rev. 
ed. Washington, D.C.; Government 
Printing Office, 1990. 

Gosselin, Robert E., et al. Clinical Toxicol- 
ogy of Commercial Products. 5th ed. 
Baltimore: Williams & Wilkins, 1984. 

Griffenhagen, George, and Stieb, Ernst. 
Pharmacy Museums and Historical Col- 
lections in the United States and Can- 
ada. Madison, Wise: American 
Institute of the History of Pharmacy, 
1988. 

Lewis, Walter H. Medical Botany: Platits 
Affecting Man 's Health. New York: 
John Wiley and Sons, 1977. 

McCann, Michael. Health Hazards Man- 
ual for Artists. 3rd rev. ed. New York: 
Lyons and Burford, 1985. 

The Merck Index. 11th (Centennial) ed. 
Rahway, NJ.: Merck & Co., 1989. 

Musto, David. The American Disease: Ori- 
gins of Narcotic Control New York: 
Yale University Press, 1973. 

Occupational Safety and Heakh Administra- 
tion, U.S. Department of Labor. Expo- 
sure to Hazardous Chemicals in 
Laboratories Washington, D.C.: Gov- 
ernment Printing Office, 1989- 



Physicians' Desk Reference. 44th ed. Or- 
adell, NJ.: Medical Economics Co., 
1990. 

Prudent Laboratory Practices Series. Vol- 
ume I: Disposal of Chemicals from Labo- 
ratories Washington, D.C.: National 
Academy Press, 1983. Volume II: Han- 
dling Hazardous Chemicals in Labora- 
tories Washington, D.C.: National 
Academy Press, 1988. 

Sax, N. Irving, and Lewis, Richard J. Haz- 
ardous Chemicals Desk Reference. New 
York: Van Nostrand Reinhold, 1987. 

U.S. Department of Health and Human Ser- 
vices. NIOSH Pocket Guide to Chemical 
Hazards. Washington, D.C.: Govern- 
ment Printing Office, 1987. 

United States Pharmacopeia: The National 
Formulary. 22nd rev. ed of the Phar- 
macopeia ind 17th ed. of the Formu- 
lary. Rockville, Md.: United States 
Pharmacopeial Convention, Inc., 1990. 



Ramunas Kondratas is Curator and Supervi- 
sor of the Medical Sciences Division of the 
National Museum of American History of 
the Smithsonian Institution. He is also a 
member of the Councils of the Medical Mu- 
seums Association and the American Insti- 
tute of the History of Pharmacy. 



Acknowledgments 



My thanks to Supervisory Conservator 
Nikki Horton and Museum Specialist Mi- 
chael Harris at the National Museum of 
American History and to Collections Man- 
ager Lynn Brocklebank at the Mutter Mu- 
seum in Philadelphia for their helpful 
comments and suggestions. 



62 



AUTUMN 1991 



Arsenic, Old Lace, and Stuffed Owls 
May Be Dangerous to Your Health: 
Environmental Concerns for Museum 
Personnel 



Museum personnel are accustomed 
to handling their collections with great 
care and caution. No less an area of 
concern should be the health and 
safety of the personnel themselves. 
Both museum objects and their envi- 
ronments can pose dangerous, even le- 
thal, situations. This article is intended 
to acquaint the non-specialist with 
commonly found hazards of the histori- 
cal museum. Excerpted from the Tech- 
nical Insert series of the Illinois 
Heritage Association, it offers common- 
sense measures that should be a part 
of basic collection management. 

Understanding the Risk 

Toxic materials can cause a range of 
symptoms from headaches and dizzi- 
ness to death. If ingested, inhaled, or 
absorbed through the skin, they can 
produce rashes, nausea, and violent 
physical reactions. Certain materials 
are especially dangerous in combina- 
tion with other factors; others can have 
serious long-term consequences that 
will not be evident for many years. 
Museum personnel with allergies, re- 



spiratory or cardiac problems, or such 
special physical conditions as preg- 
nancy should exercise special caution 
in handling certain types of artifacts or 
spending time in closed storage areas. 

Safety Procedures 

These fundamental guidelines 
should be incorporated into the health 
and safety program of every museum. 

1 . Never touch mouth or eyes after 
handling a museum object. 

2. Scrub hands thoroughly with 
soap and brush after touching artifacts. 
Keep fingernails short. 

3. Wear gloves when possible, and 
be careful about what touches ex- 
posed skin. Some irritants and toxic 
materials are easily absorbed. 

4. Keep a lab coat in the museum 
storage area. Wear it there only, wash 
it frequently, and do not wash it with 
other clothing. 

5. Limit the time spent in closed 
storage areas. Do not use them as 
workplaces. 

6. Keep food out of the storage 
areas, not only to di.scourage infestation 



by Patricia L. IVIiller 

63 



CADUCEUS 



but also to prevent contamination of 
the food. 

7. Keep storage and work areas 
well ventilated. Wear a respirator if 
working with toxic fumes or a particle 
mask if working with dust. 

8. Plan ahead. Consider possible 
hazards. Do not casually open con- 
tainers, inhale contents, or risk expo- 
sure to toxic fumes. 

9. Never touch to your mouth any 
thread or bead from historic textiles, 
garments, or jewelry. 

10. Receive regular tetanus shots. 

1 1 . Use a vacuum or wet mop in 
storage areas. Do not sweep. Dispose 
of the vacuum bag properly and rinse 
the mop thoroughly. 

12. Read all product labels care- 
fully, including those on items in the 
collection. Obtain Material Safety Data 
Sheets (MSDSs) from the manufactur- 
ers or distributors of solvents or other 
chemical products. 

13. Be especially careful of broken 
artifacts. Poisonous materials can 
leak from loose stuffing, mounted taxi- 
dermy specimens, or the handles of 
metal objects. 

14. Restrict young people (such as 
volunteers or the offspring of staff 
members) from spending extended 
time in storage areas. Children's me- 
tabolism and their smaller size make 
them especially vulnerable to environ- 
mental hazards. 

15. Encourage personnel to report 
and document instances of headaches, 
dizziness, or nausea. Determine if 
there might be a pattern suggesting a 
health hazard. 



l6. Appoint a health officer to mon- 
itor hazards, enforce a safety program, 
and develop an overall emergency 
and disaster plan. 

Hazards Associated with Collection 
Objects 

Some of the hazards found in mu- 
seum objects are inherent; others have 
been introduced unwittingly as at- 
tempts at preservation or restoration. 
Traces of the poisons can linger in 
such hard-to-clean places as handles, 
can leak from broken items, or can mi- 
grate from the object itself (as in the 
case of canvases treated with mercury) 
to a frame. Julia Fenn, ethnographic 
conservator at the Royal Ontario Mu- 
seum, has observed, "The presence of 
biocides is one of the most pervasive 
hazards . . . and unfortunately there is 
often very little record of what was 
used." 

Arsenic was used as a preservative 
in mounted taxidermy specimens, es- 
pecially during the last quarter of the 
nineteenth century. Many of the old 
mounts are now deteriorating, possi- 
bly exposing the arsenic-coated mate- 
rial. Arsenic is sometimes found in 
mummies, in such ethnographic ob- 
jects as baskets or items containing 
feathers or fur, and in textiles and 
clothing. 

In Victorian and Edwardian Fash- 
ion, A Photographic Study, Alison 
Gernsheim notes the toxicity of a pop- 
ular nineteenth-century vivid emerald- 
green dye that contained arsenic of 
copper. The author cites the claim of 
a Berlin physician that "no less than 60 



64 



AUTUMN 1991 



grains of arsenic powdered off from a 
single dress in the course of an 
evening's dancing . . . [would be] 
enough to kill thirty people if adminis- 
tered in doses."" The same dye was 
used in the bright-green cloth covers 
of many Victorian books, and arsenic 
was an ingredient in emerald-green 
pigments used in ceramics of the pe- 
riod. There is also evidence to suggest 
that arsenic was among materials used 
in weighted silks. Residues of arsenic 
in textiles, fabrics, and artifacts can 
pose serious hazards for museums. 
Curators should exercise special care 
in restricting public access to such 
items and should monitor staff access 
as well. 

Cyanide solutions were once com- 
mon cleaners for precious metals. 
Wet-cleaning silver- or gold-plated arti- 
facts can release deadly cyanide gas if 
the objects were so treated. Plated arti- 
facts should be cleaned under a fume 
hood, and handled with caution. Cya- 
nide was sometimes a component of 
nineteenth-century inks used in print- 
ing and wallpaper. Such papers 
should not be removed with steam. 

Fine art and decorative arts pieces 
can contain dangerous amounts of 
mercury, which was commonly used 
as a fungicide. Various artist's pig- 
ments, especially vermillion shades, 
contain mercury or mercury preserva- 
tives. Cinnabar (sulphide of mercury) 
is another dangerous pigment. Julia 
Fenn points out that canvases were 
sometimes impregnated with mercury 
in order to prevent mildew. The poi- 
son can migrate to the picture frame. 
Mercury was commonly added to the 



silvered backing of mirrors, making 
them and their adjacent frames poten- 
tially hazardous. Even certain house 
paints had high levels of mercury be- 
fore a 1990 EPA ban.'' 

The dangers of lead and lead-based 
compounds have been well publi- 
cized. Before 1976, almost all outdoor 
paints contained lead pigments. Toy 
soldiers, bullets, lead weights, sculp- 
ture, leaded glass, coins, weights, and 
seals are among the popular museum 
objects made from lead or lead-alloys. 
Ceramic glazes can contain lead or 
other poisonous substances. Flaking 
or other signs of corrosion should be 
cause for concern. As lead corrodes, it 
produces a powdery substance that is 
easily airborne. It can be inhaled or 
picked up if touched. It can cling to 
clothing and be carried from a storage 
area to other museum areas or out of 
the building. Not surprisingly, Julia 
Fenn considers lead poisoning one of 
the most common and potent hazards 
in museum collections. 

Carbon tetrachloride is a colorless 
liquid poison that is an effective grease 
solvent and spot remover. It was also 
commonly used as a fire extinguisher. 
Lethal amounts remain in some nine- 
teenth-century fire-fighting equipment, 
especially the glass balls u.sed to extin- 
guish .small blazes. If those balls were 
to explode, they could release poison- 
ous phosgene gas. Carbon tetrachlo- 
ride is also a component in certain 
pesticides, including Dowfume 75, 
registered for use by certified extermi- 
nators only. Exposure to carbon tetra- 
chloride can cause severe liver 
damaee. 



65 



CADUCEUS 



Pesticides are responsible for long- 
tenn iiamiful effects on collections and 
the humans exposed to them. Artifacts 
once treated with such powerful pesti- 
cides as DDT (widely used in the 
1940s and 1950s) can still be toxic. 
Vacuuming textiles so treated could re- 
lease the poison into the air. Current 
collection management policy recom- 
mends alternatives to chemical treat- 
ments. Integrated Pest Management 
(IPM) programs emphasize the impor- 
tance of eliminating the food, mois- 
ture, and habitats that encourage 
infestation. Sticky traps are not only 
an alternative to pesticides but can act 
as monitors because they provide a re- 
cord of the type, number, and migra- 
tion pattern of pests. Some museums 
practice limited pesticide treatments in 
controlled situations. Examples of 
chemicals used in museums are 
naphthalene (mothballs), para- 
dichlorobenzene (PDB), and dichlor- 
vos (Vapona .strips, no-pest strips). All 
are potentially hazardous, however, 
and some experts question the effec- 
tiveness of naphthalene. PDB not 
only can soften some plastics and res- 
ins but is harmful to feathers, dyes, 
leather, and bronze. It forms chlorine 
gas in closed containers, possibly 
bleaching specimens. Before using 
no-pest strips or PDB, museum staff 
should study how to use them effec- 
tively and how to control the level of 
toxicity. Artifacts should be isolated 
for treatment in a closed container 
with controlled temperature; staff 
should be equipped with appropriate 
respirators. One can avoid a disas- 
trous situation by carefully reading 



labels and consulting specialists when 
necessary. 

Some pesticides should be used 
only by certified exterminators, yet 
even professional application does not 
remove the need for caution. Termite 
extermination, for example, can pres- 
ent long-term health hazards, espe- 
cially if the treated wood is in a 
well-traveled public area, as a log 
cabin. The following pesticides are so 
potent that they are restricted to fumi- 
gation chambers — ethylene oxide 
(which can emit gases for as many as 
ten years), methyl bromide (which can 
hami rubber, furs, feathers, leather, 
woolens, and other hair fibers), and 
sulfuryl fluoride (which can harm 
metals). 

The off-gassing of formaldehyde 
from wood adhesives and resins is 
well documented. Ureaformaldehyde 
foam insulation i,s widely used in build- 
ing constRiction. Composite boards — 
including plywood, masonite, particle 
board, and fiberboard — emit formalde- 
hyde fumes that can be especially dan- 
gerous in closed storage areas, 
drawers, or cases. Formalin, an aque- 
ous solution of formaldehyde, was 
once widely used as a preservative on 
biological specimens. Formaldehyde 
qualifies as both a health hazard and a 
safety hazard; it is highly flammable, 
and growing evidence suggests that it 
is a carcinogen. " 

Poison plant material can be the 
basis of seed jeweliy, placemats, and 
other tourist items. As Julia Fenn points 
out, the attractive black and scarlet 
seeds of the rosaiy pea {Abms pre- 
catorius, also known as the precatory 



66 



AUTUMN 1991 



pea, crab's eyes, or the jequirity bean) 
were quite commonly used in jewelry, 
rosaries, on dolls and figurines, in rat- 
tles or maracas, and in Victorian and 
some Edwardian crafts. 

Much has been written about the 
hazards of storing cellulose nitrate film 
(nitrocellulose), which was widely 
used for still photography and later for 
motion picture film and x-ray film. Be- 
cause of its propensity for self-combus- 
tion and extreme instability, its 
production was halted in 1951. Any 
film manufactured before 1950 is sus- 
pect unless it is marked "safety film." 
Cellulose nitrate is on an irreversible 
course of disintegration. As it deterio- 
rates, it advances through stages of de- 
composition, producing acidic and 
oxidizing nitrogen oxide gases, which 
in turn accelerate the decomposition 
process. At low levels, these gases irri- 
tate the skin, eyes, and respiratory sys- 
tem. Decomposing film can cause 
nitric acid burns if touched. More im- 
portant, cellulose nitrate film has been 
known to combust spontaneously. 
The film burns quickly with an intense 
heat and releases highly toxic gases. ^ 

Many museums still have collec- 
tions of the celluloid (or French ivory) 
molded plastics that were popular 
from about 1870 to 1920. Light-col- 
ored, transparent, or translucent toilet 
articles, buttons, toys, and dolls were 
among the popular household items 
made from this ivory look-alike. Cellu- 
loid was also used to make convincing 
imitations of tortoise shell and mother- 
of-pearl. All such objects are on a 
course of deterioration. Heat and high 



relative humidity accelerate the pro- 
cess, as does light. 

Celluloid objects should be isolated, 
stored in ventilated and fireproof 
areas, and monitored carefully. As 
they degrade, they emit gases that are 
harmful to objects and people. Cellu- 
loid should not be exposed to high lev- 
els of light, nor exhibited for extended 
periods of time. Cold storage can slow 
the deterioration process, but if objects 
are transferred to or from this environ- 
ment, they must be carefully acclima- 
tized. 

Asbestos is a fire-resistant mineral 
fiber found in rocks. There is no safe 
level of exposure. Even minute expo- 
sure to asbestos fibers presents a 
health hazard if inhaled. Asbestos can 
be present in such household appli- 
ances as toasters, stoves, ovens, and 
clothes dryers; it is found in some ce- 
ramic glazes and in some rocks, such 
as serpentine. Asbestos was fre- 
quently used in constn.iction, espe- 
cially in insulation, shingles, siding, 
patching compounds, and floor tiling. 
Although many of these uses are now 
prohibited by law, asbestos is present 
in many buildings, especially those 
built or remodeled in the twentieth- 
century before the enactment of regu- 
lations in the 1970s. If asbestos is 
present, but not friable, it should not 
be disturbed. It should not be vacu- 
umed, as this distributes tiny fibers 
into the air. These minuscule fibers 
can be airborne for hours. The best 
course is to contact specialists to assist 
in determining a course of action. 
State or federal regulations can apply. 



67 



CADUCEUS 



Toxic minerals form anotiier cate- 
gory for concern. One expert warns 
that "At least 200 mineral species are 
known or suspected to be either very 
poisonous or cancer-causing." Hu- 
mans have a wide range of susceptibil- 
ity to this danger. Mineral fibers can 
be ingested if handled carelessly 
around food. They are hazardous if in- 
haled, some with low levels of expo- 
sure, others especially over long 
periods of time."" Minerals can also 
be the source of radioactive emissions. 
Uranium minerals have been used in 
ceramic glazes such as some colors of 
the American Fiesta Ware of the 1940s, 
and in some enamel jewelry."" 

Other hazards that might be found 
in a typical museum include colorants 
and coal-tar dyes containing harmful 
chemicals or carcinogens. Canned tins 
of food have been known to explode, 
causing the possibility of contracting 
botulism. Even stored paper may pres- 
ent a problem. Robert Herskovitz de- 
scribes nausea, headaches, and upper 
respiratory problems experienced by 
museum workers whose desks were in 
a poorly ventilated area that also 
stored large quantities of newspa- 
pers. 

All hazards are intensified by the 
tight construction of contemporary 
buildings, which has created a phe- 
nomenon known as closed building 
syndrome. Circulation of contami- 
nated air has obvious implications for 
the health of museum personnel. Ad- 
ministrators need to be aware of poten- 
tial health hazards. Appointing a 
health and safety officer, monitoring 
conditions and exposure, and enforc- 



ing procedures are important steps in 
keeping the workplace safe. There are 
legal as well as ethical reasons to estab- 
lish such a program. 

Further Assistance 

Numerous resources can provide 
guidance in managing the risk in mu- 
seum collections. With expert help, 
tests can be conducted to detect the 
presence of such materials as arsenic, 
asbestos, or cellulose nitrate. Advice is 
available from several private and gov- 
ernmental agencies. Supply houses 
are excellent sources of information 
for special equipment to reduce expo- 
sure to hazards. 

Resource Agencies 

For the complete "Arsenic and Old Lace 
May Be Dangerous to Your Health," includ- 
ing an extensive bibliography, write the Illi- 
nois Heritage Association, 602 1/2 East 
Green Street, Champaign, IL 61820. 

The Center for Safety in the Arts (for- 
merly the Center for Occupational Haz- 
ards; 5 Beekman Street, Suite 1030, New 
York, NY 10038; [212] 227-6220) is the 
most comprehensive source of information 
concerning safety hazards. It offers numer- 
ous low-cost publications and Art Hazards 
News. The Art Hazards Information Center 
answers telephone and written inquiries 
about health hazards in museums. 

The National Institute for the Conserva- 
tion of Cultural Property (3299 K Street 
NW, Washington, DC 20007; [202] 625- 
1495) has published an extensive bibliogra- 
phy on the conservation and maintenance 
of collections; some entries deal specific- 
ally with safety issues. 



68 



AUTUMN 1991 



National Institute for Occupational 
Safety and Health (N4676 Columbia 
Parkway, Cincinnati, OH 45226; 1-800- 
35N-IOSH) conducts research, answers in- 
quiries, and conducts health hazard 
evaluations. NIOSH-funded Educational 
Resources Centers ( ERCs) not only con- 
duct research on occupational safety and 
health issues but also provide technical as- 
sistance to employers. 

Occupational Safety and Health Admin- 
istration (200 Constitution Avenue, NW, 
Washington, DC, 20210; [2021 523-8151 ) en- 
forces the Occupational Health and Safety 
Act by promulgating health and safety stan- 
dards, conducting inspections, and fining 
violators of OSHA standards. The OSHA 
State Consultation Service is an OSHA- 
funded, on-site service that provides free 
inspections if requested by employers; it is 
not an enforcement program or a part of 
OSHA. 

Society for the Preservation of Natural 
History Collections (SPNHC Treasurer, Sue 
McLaren, 5800 Baum Blvd., Pittsburgh, PA 
15206) is a national membership organiza- 
tion. 

Supply Sources 

Safety equipment itself can present haz- 
ards if used inappropriately. Pamphlets 
from such organizations as the Center for 
Occupational Hazards describe the use of 
safety equipment and protective clothing. 
The product engineering departments of 
supply houses can provide additional infor- 
mation. All equipment should be NIOSH 
approved. Two such supply hou,ses are: 
Lab Safety Supply Inc., P.O. Box 1368, 
Janesville, WI 53547-1368; 1-800-356-0738 
or FAX (608) 754-1806; and Direct Safety 
Company, 7815 South 46th Street, Phoenix, 
AZ 85044; 1-800-528-7405; for technical as 
sistance call 1-800-462-3140, or FAX (602) 
438-1690. 



Notes 

1. Julia Fenn, "Hazards in the Collec- 
tion; Part One," Journal of the Ontario Mu- 
seum Association 17 (February 1989): 31. 

2. Alison Gernsheim, Victorian and 
Edwardian Fashion-. A Photographic Sur- 
vey (Nev^ York: Dover Publications, 1963), 
p. 54. 

3. Robert Herskovitz, "Beware the Arti- 
fact: Hazards in Museum Collections," Au- 
diotape of the 1986 Annual Meeting of the 
American Association for State and Local 
History, Oakland. 

4. Michael McCann, Health Hazards 
Manual for Artists. 2nd ed. (New York: 
Foundation for the Community of Artists, 
1981). 

5. Fenn, p. 31. 

6. Angela Babin, "Research and Regu- 
lation on Mercury Paint," Art Hazards 
News. Vol. 13, No. 9 (1990): 3. 

7. Karen Yager, "Health and Safety for 
Historic Structures Pre,ser\'ation, ' Center 
for Occupational Hazards data sheet 
(1986), p. 5. 

8. Fenn, p. 32. 

9. Herskovitz. 

10. Petri Peltz and Monona Rossol, 
"Safe Pest Control Procedures for Museum 
Collections," Center for Safety- in the Arts 
data sheet (1983), p. 4. 

11. Wendy Clair Jessup, "Pest Manage- 
ment Notes: Establishing a Pest Monitoring 
Program for Museums," Technical Bulletin 
1. Oklahoma Field Advisory Service (Okla- 
homa City: Oklahoma Museums Associa- 
tion and the Oklahoma Historical Society), 
as published in MuseNews, July, 1989. 

12. Herskovitz, Peltz and Ros.sol, 
pp. 4-5. 

13. Abbey Neu'sletterM (iuni: 1987): 53. 

14. Fenn, p. 30. 

15. Babin, "Celluloid Film Hazards in 
Conservation," Art Hazards News, August, 
1990, p. 3. 



CADUCEUS 



16. Ibid. 

17. R. Scott Williams, "Display and 
Storage of Museum Objects Containing Cel- 
lulose Nitrate," CC/ (Canadian Conserva- 
tion Institute! Notes. April, 1988. 

18. U.S. Consumer Product Safety Com- 
mission, U.S. Environmental Agency, Asbes- 
tos in the Home CWnshington, D.C.: U.S. 
Government Printing Office, 1985), pp. 2, 

t. 

19. John H. Puffer, "Toxic Minerals," 
Mineralogical Record II (1980): 5. 

20. Ibid., p. 9. 

21. Rossol, "Radioactive Enamels 
Banned," Art Hazards News , Vol. 7, No. 8 
(1984), p.2. 

22. Herskovitz. 



Patricia L. Miller is Executive Director of 
the Illinois Heritage Association, Adjunct 
Professor in ttie Department of Urban and 
Regional Planning at the University of Illi- 
nois at Urbana, and Visiting Professor in 
the Historical Administration Program at 
Eastern Illinois University. She is also the 
coauthor of A Commemorative History of 
Champaign County, Illinois, 1833-1983. 



Acknowledgments 



The following colleagues have provided in- 
formation for this article: Thomas A. Reitz, 
Doon Heritage Crossroads, Kitchner, On- 
tario, Canada; Linda Norbut Suits, Lincoln 
Home National Historic Site, Springfield, 
III.; Timothy Talbott, Early American Mu- 
seum, Mahomet, III.; and Barbara Zucker, 
Carbondale, III. 



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